Breaking the 12-Hour Barrier: Urgent Community Response in the ED
Abstract
Introduction:
Prolonged emergency department (ED) length of stay beyond 12 hours is a performance priority and disproportionately affects older adults presenting with falls and mobility impairment.
We evaluated a pilot integrating Urgent Community Response (UCR) clinicians within the ED frailty service to support early assessment, admission avoidance, and timely discharge.
Methods:
A five-day service evaluation was undertaken from 12th – 16th May 2025. A UCR matron was co-located with the ED frailty team from 08:00–18:00.
Patients were jointly identified through screening of the ED board and Rapid Assessment and Triage (RAT) stream. The intervention targeted patients presenting with falls, reduced mobility or functional decline who were at risk of admission.
Outcomes included patient flow, community referral efficiency, ambulance conveyance avoidance and the number of patients exceeding a 12-hour ED stay.
Results:
Across the pilot, 49 patients were reviewed by UCR staff. Eight were referred directly from ED RAT, all within the first hour of attendance, with clear discharge plans established early and minimal delay once medically cleared.
The majority presented with falls or mobility-related issues that could have necessitated admission.
Twelve direct UCR referrals were generated by the frailty team, most added immediately to the UCR caseload by on-site matrons, improving discharge efficiency.
Three ambulance conveyances were avoided through real-time UCR advice to community and ambulance colleagues.
Compared with the preceding week, the number of patients remaining in the ED for over 12 hours fell from 172 to 93, reducing the daily average from 34 to 19.
Run-chart data demonstrated sustained performance for the 12-hour threshold throughout the trial.
Conclusion:
Embedding UCR clinicians within the ED frailty team reduced prolonged ED stays while supporting patients with falls and mobility impairment, highlighting a model for improving flow.