Implementing Microhospital Emergency Medicine in an Academic Emergency Department: A Framework for Academic Health Systems.

Background: Academic emergency medicine faces significant challenges, including capacity constraints at tertiary care centers and financial stressors. Objectives: Herein, we describe a framework for integrating microhospital emergency departments into a large academic health system as a means of growing an academic emergency department amidst these pressures. The addition of these microhospitals has allowed us to level-load our trauma center and efficiently deliver high patient satisfaction while requiring far smaller initial investment and operating costs when compared with a traditional hospital. Discussion: In the model we implemented, operational efficiency is attained via several means, including the use of a lean staff model that emphasizes cross-training of staff, point-of-care laboratory testing, and rapid triage and bed assignment of patients. Some challenges encountered with the establishment of these microhospitals included maintaining a sufficient inpatient census for accreditation and maintaining the critical care skills of staff at these facilities, which typically see lower acuity, less complicated patients. Despite these challenges, our facilities have performed well both financially and operationally. Conclusion: We present a model integrating microhospital emergency departments within an academic emergency department positively impacting capacity and operational challenges at the academic center while being financially feasible.