Next Day Clinic for Patient Care

(NDC Trial)

Overseen By Richard Leuchter, MD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of California, Los Angeles

Disqualifiers: Pregnant, Hospice, Cancer, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 1

1080 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to improve patient care by providing an alternative to hospital admission for those with less severe conditions. Participants typically admitted through the emergency department for certain conditions might instead visit a specialized clinic, known as the Next Day Clinic, the following day. This approach reduces hospital crowding and enhances care quality. Good candidates have insurance that permits follow-up at UCLA Health and are at risk of avoidable hospitalization based on specific lab results and vital signs. Participants must also have even-numbered birth dates, as this determines clinic eligibility. As an unphased trial, the study offers participants the chance to contribute to innovative healthcare solutions that may enhance patient experiences and outcomes.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to consult with the trial coordinators or your healthcare provider for guidance.

What prior data suggests that this protocol is safe for patient care?

Research has shown that the Next Day Clinic (NDC) effectively reduces the time patients spend in the hospital. At Olive View Hospital, for example, the NDC saved over 500 hospital bed-days in less than a year. This demonstrates that the clinic can provide necessary care without admitting patients to the hospital.

Similar clinics have previously shown that many hospital admissions can be avoided due to reasons like diagnostic uncertainty or lack of follow-up care. The NDC aims to deliver high-quality care the day after an emergency department visit, helping manage health issues without requiring a hospital stay.

Regarding safety, specific data about the NDC is limited. However, its focus on outpatient care and sustained operation suggests a level of safety and acceptance in the healthcare community. This type of clinic is designed to provide appropriate care without hospital admission, naturally reducing risks like hospital-acquired infections. While specific data on negative events is not detailed, the ongoing operation of similar clinics indicates they are generally well-received by patients. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Next Day Clinic initiative because it offers a fresh approach to managing patient care after an emergency department visit. Unlike the standard route of immediate hospitalization, this method provides patients the option to receive follow-up care the next day, potentially reducing the need for hospital stays. This approach not only aims to enhance patient comfort and convenience but could also help decrease healthcare costs and alleviate hospital overcrowding. The trial is a novel attempt to see if patient outcomes can be maintained or even improved by minimizing unnecessary admissions.

What evidence suggests that the Next Day Clinic is effective for improving patient care and safety?

Studies have shown that the Next Day Clinic (NDC), available to participants in this trial, can reduce hospital admissions. In one study, over 80% of patients attended their NDC appointments, easing pressure on the emergency department (ED). Another study found that similar clinics reduced ED visits for adults by 48%. This suggests that transferring patients from the ED to a specialized clinic the next day can be effective. The NDC aims to provide better care and save money by avoiding unnecessary hospital stays. ^{6 7 8 9 10}

Are You a Good Fit for This Trial?

The UCLA Next Day Clinic trial is for patients who visit the emergency department with conditions like diabetic foot, osteomyelitis, cellulitis, kidney issues, heart failure, pneumonia or fainting. These should be low-acuity cases that normally would require hospital admission.

Inclusion Criteria

I was identified as at risk for hospitalization during an emergency visit.

Insurance that authorizes the patient to follow-up at UCLA Health, or self-pay

I am being admitted or have been admitted for a specific diagnosis listed in the study.

Exclusion Criteria

I am being evaluated for an organ transplant.

I have a lung condition like pulmonary fibrosis.

Pregnant

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Next Day Clinic Treatment

Participants with even birthdays who meet inclusion criteria receive care in the Next Day Clinic to avoid hospitalization

1 day

1 visit (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment

30 days

Evaluation and Analysis

Analysis of patient outcomes, cost effectiveness, and hospital bed-days saved

12 months

What Are the Treatments Tested in This Trial?

Interventions

• Next Day Clinic

Trial Overview This study tests a new approach where instead of admitting certain patients to the hospital from the ED, they are sent home and return to a high-acuity clinic called NDC the next day. The goal is to improve care quality and cost-effectiveness.

How Is the Trial Designed?

Group I: Next Day Clinic Experimental Treatment 1 Intervention

Patients with even birthdays who meet inclusion criteria will be given the option to receive care in the Next Day Clinic to avoid hospitalization.

Group II: ED-initiated hospitalization Active Control 1 Intervention

Patients with odd birthdays will be routed to standard-of-care ED-initiated hospitalization pathways.

Who Is Running the Clinical Trial?

University of California, Los Angeles

Lead Sponsor

Trials

1,594

Recruited

10,430,000+

Published Research Related to This Trial

In a study at a high-volume outpatient cancer clinic, baseline patient wait times averaged 71 minutes, with factors like over-scheduling contributing to delays.

Implementing quality improvement strategies, such as standardizing scheduling and load-leveling, led to significant reductions in wait times, with one physician reducing their average wait from 122 minutes to 52 minutes (a 57% decrease).

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Reducing patient wait times in a head and neck cancer outpatient clinic: A pilot study. Silver, N., Weber, RS., Lozano, M., et al.[2020]

A study conducted over 2 years at a community hospital involved 581 patients undergoing day care surgery, demonstrating that elective operations can be performed safely with high patient satisfaction and minimal hospital stays.

Quality control measures showed that 98.5% of patients received follow-up care, indicating effective monitoring and management of outcomes, with a variety of common procedures performed, including arthroscopies and hernial repairs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Ambulatory surgery clinic in a public general hospital. Organization and results]. Scheidegger, A., Biaggi, J.[2019]

The implementation of a same clinic-day surgery (CDS) program led to high patient satisfaction, with 79% of parents reporting decreased stress and anxiety, and 95% expressing willingness to use the program again.

Despite positive feedback from patients, faculty and staff identified challenges such as low enrollment and issues with continuity of care due to different surgeons evaluating and operating on patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Clinic-day surgery for children: a patient and staff perspective. Criss, CN., Brown, J., Gish, JS., et al.[2018]

The establishment of a Same-Day Clinic (SDC) significantly improved access to surgical care, reducing the percentage of patients referred after emergency department visits from 33.4% to 17.9%.

Patients seen in the SDC experienced shorter wait times for surgery, with an average wait of 29 days compared to 40 days before the clinic was created, while also decreasing unnecessary preoperative imaging from 58.9% to 44%.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Same-Day Surgery Clinic: A model for improving access to care at academic medical centers. Adams, U., Buckio, J., Schreiber, E., et al.[2023]

In a study of 744 patients undergoing laparoscopic cholecystectomy, 19% were selected for day-case surgery, with 84% successfully discharged on the same day, indicating that this approach is feasible and safe for carefully chosen patients.

Patient satisfaction was high, with 94% of those surveyed expressing satisfaction with their day-case surgery experience, suggesting that this method not only benefits healthcare efficiency but also enhances patient comfort.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Day-case laparoscopic cholecystectomy: a prospective evaluation of a 6-year experience. Ammori, BJ., Davides, D., Vezakis, A., et al.[2004]

In a study of 236 patients undergoing laparoscopic cholecystectomy, 44.9% successfully had the procedure as a day care surgery, demonstrating its feasibility in a developing country setting.

The procedure was found to be safe, with only 4.8% of patients requiring admission post-surgery, and no major complications reported, indicating high patient acceptance and satisfaction.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Relevance of day care laparoscopic cholecystectomy in a developing nation. Kaman, L., Verma, GR., Sanyal, S., et al.[2015]

A study analyzing 12,052 pediatric otolaryngology clinic visits showed that implementing standardized physician templates reduced average visit time by 10.5% (from 52.3 to 46.8 minutes), which could save approximately 1,567 clinic hours annually.

The process improvement strategies did not negatively impact patient experience, indicating that efficiency can be enhanced in high-volume clinics without sacrificing quality of care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Utilizing process improvement strategies to generate clinic templates and improve patient flow in pediatric otolaryngology. Kubala, M., Gardner, JR., Criddle, J., et al.[2021]

Nurse-led clinics in a hospital urology department have been effective in improving outpatient care efficiency and reducing patient waiting times.

The article outlines the training and development audit results for these clinics, highlighting the role of advanced nurse practitioners in enhancing the patient care pathway.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Empowering advanced practitioners to set up nurse led clinics for improved outpatient care. Lane, L., Minns, S.[2022]

Citations

1. clinicaltrials.gov clinicaltrials.gov/study/NCT06526884

Quasi-Randomized Evaluation of the UCLA Next Day ... The UCLA Next Day Clinic (NDC) study aims to improve care by diverting patients with low-acuity conditions from the ED to a high-acuity clinic the next day, ...

2. uclahealth.org uclahealth.org/departments/medicine/internal-medicine/education/thinq-collaborative/current-programs

Current Programs - Internal Medicine NDC is an initiative that aims to improve patient care and safety in the Emergency Department (ED) while maximizing cost effectiveness. The NDC team identifies ...

3. sciencedirect.com sciencedirect.com/science/article/pii/S0735675725002943

Creating a post-ED rapid clinic follow-up program More than 80 % of patients attended their appointments, 74 patients had one or more repeat visits to the ED within seven days with 26 patients (3.5 %) admitted ...

4. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12088314/

Urgent care centres for reducing the demand on emergency ... A first‐time visit to the UCC was associated with a 48% reduction in ED visits for adults and a 28% reduction for children during the six months ...

5. annemergmed.com annemergmed.com/article/S0196-0644(16)30083-X/fulltext

The Effectiveness of Emergency Department Visit ... The study found no reductions in ED visits at 12-month follow-up comparing intervention to usual care groups (adjusted mean difference –0.23; 95% confidence ...

6. ctsi.ucla.edu ctsi.ucla.edu/the-us-could-experience-a-critical-hospital-bed

The U.S. could experience a critical hospital bed shortage ... In less than one year, the Olive View Next Day Clinic saved over five hundred hospital bed-days and $1.09 million, receiving an award for “Top ...

7. shmabstracts.org shmabstracts.org/abstract/next-day-clinic-to-prevent-avoidable-hospitalizations-13-months-of-a-novel-hospital-avoidance-model/

13 MONTHS OF A NOVEL HOSPITAL AVOIDANCE MODEL Background: Ten to twenty percent of U.S. hospitalizations are avoidable, driven by clinical uncertainty, social factors, or lack of access ...

8. uclahealth.org uclahealth.org/patient-resources/prepare-your-visit/next-day-clinic

Next Day Clinic The Next Day Clinic is a comprehensive follow-up care program for patients who need ongoing hospital-level treatment after a visit to the ED or hospital.

9. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC3475839/

After-Hours Care and its Coordination with Primary Care in ... Five models of after-hours care coordinated with primary care were identified: 1) Same PCP, all the time; 2) PCP plus practice partners; usually limited ...

10. data.cms.gov data.cms.gov/provider-data/topics/hospitals/unplanned-hospital-visits

Unplanned hospital visits | Provider Data Catalog Unplanned hospital visits are measured within 7 or 30 days after visiting the hospital or having an outpatient procedure.