The impact of a universal admission order on health system capacity

In our health system with multiple campuses, a universal admissions order (UAO) was introduced to further improve patient flow. We hypothesized that the UAO would more evenly distribute health system capacity, with an increase in admissions to the community affiliate sites. Inpatient and emergency department (ED) metrics were evaluated, and included total admissions, admissions to each clinical site from each ED, the time to the inpatient bed being ready to receive the ED patient, boarding times, and the left without being seen rate. After implementation of the UAO, the average time to inpatient beds being ready to accept ED patients decreased at all three clinical sites by an average of 25 minutes. Admissions were more evenly distributed amongst the three clinical sites, with 3% of all admissions admitted to a new campus. While there were likely other variables at play, there was system-wide reduction in the time to inpatient beds being ready to accept ED patients, and an improvement in boarding at the main clinical site. Our work suggests that a UAO could be a useful adjunct to central capacity management in a health system with multiple clinical campuses.