Evaluation of a High-Acuity Next Day Clinic for Hospital Admission Avoidance: A 13-Month Cohort Study

ImportanceHospital capacity constraints and rising healthcare costs necessitate innovative models for delivering acute care. While various hospital-substitution models exist, challenges in scalability and long-term viability persist. ObjectiveTo evaluate the feasibility and safety of a novel, high-acuity Next Day Clinic (NDC) as an alternative to hospitalization for select acutely ill emergency department (ED) patients. Design, Setting, and ParticipantsRetrospective matched cohort study of patients referred to the NDC between July 1, 2023-July 31, 2024, matched to patients seen in the ED during the year prior to NDC launch, within a large academic safety-net hospital. InterventionHigh-acuity outpatient therapy for one or more consecutive days in the NDC, consisting of daily IV antibiotics or diuretics, STAT labs, and rapid turnaround imaging and cardiodiagnostics. Main Outcomes and MeasuresDays alive and out of hospital (DAOH) in the 30 days following the index ED visit. Secondary outcomes were the number of hospital bed-days avoided, as well as 30- day ED revisits, hospital readmissions, and mortality. ResultsThe NDC had 1009 encounters (mean age, 54.4 years [SD 14.6]; 448 female [44%]) during the study period, 420 (42%) of which were referred from the ED. Of these, 298 (71%) matched to 4666 ED visits (mean age, 53.3 years [SD 15.2]; 2019 female [43%]) in the year prior to NDC launch on age, sex, the first set of laboratory and vital sign data obtained in the ED (i.e., presenting illness severity), and an exact match on primary diagnosis group. Unadjusted mean DAOH in the NDC cohort was 29.5 days (SD 2.3) compared to 24.9 days (SD 5.5) in the control cohort. Adjusting for the same features in the matching algorithm showed NDC treatment was associated with an average of 3.85 (SD 0.20) more DAOH compared to hospitalization (p<0.001), translating to 358-1294 hospital bed-days saved over the study period. NDC patients had significantly higher rates of 30-day ED revisits per 100 encounters (20.5 versus 13.0, p<0.001), but significantly lower rates of 30-day hospital readmissions per 100 encounters (5.7 versus 11.0, p<0.001) and morality (0% versus 0.9%, p<0.001). Conclusions and RelevanceThe NDC is a feasible and safe alternative to hospitalization, and promising strategy for managing ED and hospital capacity and reducing healthcare expenditures. KEY POINTSO_ST_ABSOuestionC_ST_ABSIs a high-acuity Next Day Clinic (NDC) a feasible and safe alternative to hospitalization for acutely ill emergency department (ED) patients? FindingsIn this matched cohort study of 1009 NDC encounters, 298 hospital admission avoidance referrals were matched with 4666 historical controls. Each avoided hospitalization through the NDC was associated with an average of 3.85 more days alive and out of the hospital over 30 days, lower readmissions and mortality, and a total of 358-1294 hospital bed-days saved. MeaningA centralized, high-acuity outpatient clinic may safely substitute for hospitalization, reducing hospital capacity strain and healthcare expenditures.