quasi-randomized evaluation of the ucla next day clinic (ndc)

Conditions: Pneumonia; Syncope; Congestive Heart Failure; Cellulitis; Pyelonephritis; AKI - Acute Kidney Injury; Diabetic Foot Infection; Osteomyelitis

Summary: the next day clinic (ndc) is a quality improvement initiative that will be launched and operated by ucla health starting july 22, 2024. its goals are to improve patient care and safety and to maximize cost effectiveness. the way it does this is by identifying patients in the ed who would normally be admitted for low-acuity conditions, and diverting them to a high-acuity clinic the following day called the ndc. this will help decompress the ed and the hospital, and allow for overall higher quality care. the health system has partnered with ucla's healthcare value analytics and solutions \[uvas\] group which specializes in these types of program evaluations. the analysis conducted by the study team will be used to directly inform ndc operations, scaling, and future plans.

ndc is a hospital avoidance model with the potential to simultaneously improve the quality and safety of acute care, reduce costs, and address hospital/ed overcrowding. this novel hospital avoidance program will divert patients from the ed who have been diagnosed with the following conditions and meet certain clinical criteria: * diabetic foot infection/osteomyelitis * cellulitis * congestive heart failure * syncope * pyelonephritis/urinary tract infection * pneumonia * acute kidney infection

Eligibility criteria:
inclusion criteria: * 18 years of age or older * about to be admitted through the ed for one of the ndc diagnoses or a synonym (per study protocol document), defined by the presence of a plan to admit order or bed request order, or recently admitted under observation or inpatient status for one of the ndc diagnoses. * identified as at-risk for an avoidable hospitalization in the ed based on a pre-determined set of lab and vital parameters. * insurance that authorizes the patient to follow-up at ucla health, or self-pay * admitted or being admitted to an internal medicine service exclusion criteria: * heart or lung transplant recipient with concern for graft dysfunction * pregnant * enrolled in hospice * resides in or discharged to a skilled nursing facility/acute rehabilitation facility * admitted to a critical care service * ed deems discharge unsafe due to complex social or medical factors * active malignant cancer (per council of state and territorial epidemiologists value set) * pulmonary arterial hypertension (per joint commission value set) * undergoing workup for solid organ transplant * interstitial lung disease (including pulmonary fibrosis) (per higher level 7 value set) * requiring inpatient procedure or surgery defined by the presence of an anesthesia event or operating room encounter. * the ed deems discharge unsafe due to complex social or medical factors. * transferred to an ineligible hospital note: the health system plans to limit the volume of referrals to the ndc by only referring patients who have an even birth date (this is more equitable than first-come-first-serve, because wage workers are more likely to come to the ed later in the day; even/odd birth date theoretically keeps more spots open for patients presenting to the ed later).

Keywords: patient safety cost effectiveness avoidable hospitalizations