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The Impact of a Concierge Medicine Model on Door to Doctor Time and Patient Flow in an Urban Emergency Department

Authors Mandel AL, Bove T, Parekh AD, Datillo P, Bove J Jr, Bove L, Bove JJ, Birkhahn RH

Received 22 August 2019

Accepted for publication 27 January 2020

Published 11 February 2020 Volume 2020:12 Pages 13—18


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Hans-Christoph Pape

Asher L Mandel, Thomas Bove, Amisha D Parekh, Paris Datillo, Joseph Bove Jr, Linda Bove, Joseph J Bove, Robert H Birkhahn

Department of Emergency Medicine, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA

Correspondence: Robert H Birkhahn
Department of Emergency Medicine, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY 11215, USA
Tel +1 718 780 5040
Fax +1 718 780 3153

Introduction: Emergency Department (ED) crowding negatively impacts patient outcomes, patient satisfaction, and patient safety. One solution involves introducing a Concierge Physician (CP) whose sole purpose is to provide a brief initial assessment (BIA) and aid patient navigation through the ED. The goal of this study was to quantify the impact of a CP on patient flow dynamics in an urban ED setting.
Methods: We performed a retrospective observational cohort study in an urban academic ED over a 6-month period. Initially, the CP was present in the treatment area during weekdays; during the last half of the observation period, an additional CP was added to the waiting room on weekends. We identified four major milestones in the ED visit with regards to patient throughput. Adult patients presenting to the ED with a triage level of Urgent (ESI 3) were analyzed for this study. Data were stratified based on the patient’s ultimate disposition (admitted or discharged) and presented as means with predictive analysis.
Results: Between August 2016 and January 2017, the ED evaluated 42,397 adult patients. Of those, 26,976 (64%) were triage level Urgent (3). Of the level 3 patients, 10,279 (38%) received a BIA from a CP. Patients evaluated by a CP were seen approximately 30 mins faster (40% reduction in Door to Doctor time), but stayed 30 mins longer in the ED on average, because the medical decision-making process took > 1 hr longer when the patient was initially evaluated by a CP.
Conclusion: Adapting a concierge medicine model to rapidly evaluate patients resulted in a dramatically reduced Door to Doctor time, but an increase in overall time spent in the ED. This discrepancy was a direct result of the delay in physician disposition.

Keywords: metrics, Door to Doctor time, administration

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