The development and implementation of a direct admission system at a tertiary care hospital

Health care reform and changes in the levels and models of reimbursement have resulted in hospitals focusing on efficiency and examining patient flow, especially in emergency departments (EDs). Improving the throughput of patients in the ED has been addressed in various ways, including the development of direct admission systems in which patients needing admission but not emergent care can bypass the ED altogether. The development process of such systems has not been addressed in the medical literature. We review the development and implementation of a direct admission system at a tertiary care hospital, including a review of existing direct admission systems. Our new direct admission system replaced a confusing, ill-defined process that was a perceived and later survey-confirmed source of frustration for all involved and a source of resource waste and delays in care. This study also highlights a collaborative process among hospital personnel, including hospitalists, to address hospital efficiency in a meaningful way. The described process can be generalized to other hospitals.