Emergency department (ED) arrivals are surging in hospitals across the United States, with many systems facing significant capacity challenges. Identifying effective and safe alternative dispositions for patients is one solution to the capacity and boarding crises.

Our health system created a rapid post-ED evaluation follow-up process through enterprise-wide collaboration among multiple service lines. This system allowed for real-time payer agnostic scheduling of rapid subspecialty and primary care outpatient follow-up appointments for ED patients as a safe alternative to hospital admission.

During the first 12 months of the program, 735 referrals were ordered by the ED physicians with 551 (75 %) of appointments identified to have safely averted a hospital admission on retrospective review by a physician oversight leader.

Program safety was measured by appointment completion and return ED visits within 1 week. More than 80 % of patients attended their appointments, 74 patients had one or more repeat visits to the ED within seven days with 26 patients (3.5 %) admitted on the subsequent visit. No patients required an escalation of inpatient care to an intensive care or intermediate care unit.

The post-ED rapid clinic follow-up program has been successful and provided a safe alternative to hundreds of patients who would otherwise have been admitted and often boarding in our ED for hours to days. Health systems dealing with capacity challenges may consider implementing an individualized version of this program.

Follow up

Overcrowding

Capacity

Boarding

Alternative disposition

ED operations

ED administration

© 2025 The Authors. Published by Elsevier Inc.