Use of tent for screening during H1N1 pandemic: Impact on quality and cost of care

OBJECTIVE: This article aimed to assess the impact on quality and cost of care of using a tent in the emergency department (ED) parking lot to screen patients with an influenza-like illness (ILI). METHODS: A nurse-driven protocol was used to triage and perform a medical screening examination for patients with ILI who could be safely discharged from the tent. A before-after study design was used to assess the intervention, focusing on the immediate pre-tent and tent periods, when the average daily census exceeded 250 visits (67% above our historic baseline). We compared quality and cost data on patients treated for ILI before and while the tent was in operation. RESULTS: During the pre-tent and tent periods, 5809 and 5864 encounters, respectively, were recorded in the ED; elopement rates were 12.9% and 1.8% of patients, respectively. Of the 1141 patients screened in the tent, 838 were triaged out. Average ED turnaround time for all patients was 282 and 152 minutes, with an overall rate of ED recidivism of 5.03% and 5.36% (1.8% for ILI-related revisit for tent patients) during the pre-tent and tent periods, respectively. The average cost of screening was $30.45 per patient. The incremental cost-effectiveness ratio, representing the additional cost to decrease the elopement rate by 1%, was $697.30, with the tent being the dominant strategy. CONCLUSIONS: The tent provided cost-effective care with measurable improvements in quality of care indicators. Our analytic model demonstrated that the incremental cost-effectiveness ratio of tent during the H1N1 surge was modest. The tent may be a useful model during future pandemics.