Can an ED-led Acute Care Clinic Increase Primary Care Access and Improve Crowding?

Figure 1: ED visits with length of stay (LOS) under 160 minutes increased after clinic implementation.Primary care and emergency medicine are both often under-resourced and subject to demand surges that challenge efficiency. If a patient encounters barriers in the health system, such as difficulties getting their medications refilled, delays in receiving lab results, or questions that cannot be answered via triage phone lines, care often gets directed to the emergency department (ED), where a team of dedicated problem-solvers will then tackle the issue head-on. The ED is open 24/7, and despite the wait, patients know they will eventually be seen and their most crucial problem can often be addressed. Unfortunately, the ED's accessibility may contribute to crowding and encourage inappropriate patient care–seeking behaviors of low-acuity concerns.1 Building capacity for same-day urgent visits remains challenging for a number of reasons, and this is well understood.2 We shared the results of our local quality improvement work to address this issue facing patients and health care team members at the ACEP Research Forum in September 2025.3 Our group at Hennepin Healthcare (a single system of neighborhood clinics, Level 1 trauma center, and safety-net hospital) started a collaborative solution to address high volumes of low-acuity ED visits. We established an Acute Care Clinic (ACC), which sees patients referred directly from the ED. Our clinic consists of one patient scheduling representative, two medical assistants, a nurse practitioner, and two physician assistants, and is located across the street from the ED in our outpatient Clinic and Specialty Center. Patients are able to schedule 24 hours in advance of their visit via RN telehealth, or are referred directly to the ACC from ED triage by an emergency physician (EP) screening all arrivals to the ED. This model has allowed us to ensure that patients are screened and stabilized, per EMTALA mandate (and optimal patient care), and also offer patients expedited visits in the right setting. It has been a natural evolution of our Physician in Triage model, with the EP directing the overall vector of patient care. We initiated an IRB-approved local institutional quality improvement project to review patient visits seen in the ACC. Charts were reviewed for age, chief complaint, billing level, and primary care clinic follow-up scheduled within 30 days after the ACC visit via Epic Caboodle database through the Slicer Dicer tool. A total of 3,327 patients were seen in the ACC over an eight-month period. After patients were seen in our clinic, 13% attended a follow-up primary care visit within 30 days. This was higher than our ED sample over the same period in which only 8% of patients had a primary care visit within 30 days. ED left-before-discharge rates trended toward a decrease after ACC implementation (P = .058), but left-without-being-seen rates did not decrease. The percentage of ED patients with total length of stay (LOS) under 160 minutes gradually increased over the course of clinic implementation (Figure 1). Because primary care remains in an under-resourced, crisis state, this model represents an ED-based solution that was able to improve patient access to primary care and mitigate some of the effects of ED and system overcrowding. If the clinic had not been open, it is unclear where these individuals, who were diverted from RN telehealth and the ED, would have sought care. The clinic did not decrease volume of low-acuity (Emergency Severity Index Level 5) visits, a known issue in this area.4 However, we hypothesize that increasing primary care access to outpatient visits via an ED-led acute care clinic may be associated with beneficial trends to improve aspects of ED LOS and decreasing rates of patients leaving before ED discharge. Further study in this area is warranted. Additional solutions, such as improving telehealth triage and post-acute follow-up clinics, are indicated to reduce low-acuity ED visits and promote the right care for patients, at the right place, at the right time, rather than having them wait six hours in triage for a work-up while highly acute patients are prioritized. Nationally, we risk spending enormous amounts of money on ED care. if we do not begin long-term investment in preventative health for patients who are seeking care in the ED (Figure 2).Figure 2: The majority of patients were scheduled by ED Scheduler, followed by RN Telehealth and then local nursing team members, primarily in our clinic building (Other).Further upstream efforts, such as utilizing 911 to triage patients to telehealth providers, have also been discussed to decrease volumes of EMS runs and ultimately referrals to the ED. Each solution has unique latent risks and opportunities, which should be evaluated accordingly. Ultimately, a multipronged approach is likely needed to help our patients reconnect to outpatient care, decongest our EDs, and let us be stewards of this valuable resource for patients needing high-acuity medical care. DR DAVIDSON practices primary care and emergency medicine in Minneapolis, MN.