Quasi-Randomized Evaluation of the UCLA Next Day Clinic (NDC)

NDC is a hospital avoidance model with the potential to simultaneously improve the quality and safety of acute care, reduce costs, and address hospital/ED overcrowding. This novel hospital avoidance program will divert patients from the ED who have been diagnosed with the following conditions and meet certain clinical criteria:

• Diabetic Foot Infection/Osteomyelitis
• Cellulitis
• Congestive Heart Failure
• Syncope
• Pyelonephritis/Urinary Tract Infection
• Pneumonia
• Acute Kidney Infection

Inclusion criteria

• 18 years of age or older
• About to be admitted through the ED for one of the NDC diagnoses or a synonym (per Study Protocol document), defined by the presence of a Plan to Admit order or Bed Request order, OR recently admitted under observation or inpatient status for one of the NDC diagnoses.
• Identified as at-risk for an avoidable hospitalization in the ED based on a pre-determined set of lab and vital parameters.
• Insurance that authorizes the patient to follow-up at UCLA Health, or self-pay
• Admitted or being admitted to an internal medicine service

Exclusion criteria

• Heart or lung transplant recipient with concern for graft dysfunction
• Pregnant
• Enrolled in hospice
• Admitted to a critical care service
• ED deems discharge unsafe due to complex social or medical factors
• Active malignant cancer (per Council of State and Territorial Epidemiologists value set)
• Pulmonary arterial hypertension (per Joint Commission value set)
• Undergoing workup for solid organ transplant
• Interstitial lung disease (including pulmonary fibrosis) (per Higher Level 7 value set)
• Requiring inpatient procedure or surgery defined by the presence of an anesthesia event or operating room encounter.
• The ED deems discharge unsafe due to complex social or medical factors.
• Transferred to an ineligible hospital

Note:

The Health System plans to limit the volume of referrals to the NDC by only referring patients who have an even birth date (this is more equitable than first-come-first-serve, because wage workers are more likely to come to the ED later in the day; even/odd birth date theoretically keeps more spots open for patients presenting to the ED later).