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Implementation of Vertical Split Flow Model for Patient Throughput at a Community Hospital Emergency Department

      Abstract

      Background

      Hospitals have implemented innovative strategies to address overcrowding by optimizing patient flow through the emergency department. Vertical split flow refers to the concept of assigning patients to vertical chairs instead of horizontal beds based on patient acuity.

      Objective

      Evaluate the impact of vertical split flow implementation on emergency department emergency severity index level 3 patient length of stay and throughput at a community hospital.

      Methods

      Retrospective cohort study of all emergency severity index level 3 patients presenting to a community hospital emergency department over a three month period before and after vertical split flow implementation between 2018 and 2019.

      Results

      In total, data was collected from 10,638 patient visits - 5,262 and 5,376 patient visits pre- and post-intervention, respectively. There was a significant reduction in mean overall length of stay when emergency severity index 3 patients were triaged with vertical split flow (251 minutes vs 283 minutes, p<0.001).

      Conclusions

      Community hospital emergency department implementation of vertical split flow for emergency severity index level 3 patients was associated with a significant reduction in overall length of stay and improved throughput. This model provides a solution to increase the number of patients that can be simultaneously cared for in the emergency department without increasing staffing or physical space.

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