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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 (ED). 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 ED Emergency Severity Index (ESI) level 3, patient length of stay, and throughput at a community hospital.

      Methods

      Retrospective cohort study of all ESI level 3 patients presenting to a community hospital ED over a 3-month period prior to and after vertical split flow implementation between 2018 and 2019.

      Results

      In total, data were collected from 10,638 patient visits: 5262 and 5376 patient visits pre- and postintervention, respectively. There was a significant reduction in mean overall length of stay when ESI-3 patients were triaged with vertical split flow (251 min vs 283 min, p < 0.001).

      Conclusions

      Community hospital ED implementation of vertical split flow for ESI 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 ED without increasing staffing or physical space.

      Keywords

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      REFERENCES

        • Di Somma S
        • Paladino L
        • Vaughan L
        • Lalle I
        • Magrini L
        • Magnanti M.
        Overcrowding in Emergency Department: an International Issue.
        Intern Emerg Med. 2015; 10: 171-175
        • Elshove-Bolk J
        • Mencl F
        • van Rijswijck BTF
        • Simons MP
        • van Vugt AB.
        Validation of the Emergency Severity Index (ESI) in self-referred patients in a European emergency department.
        Emerg Med J. 2007; 24: 170-174
        • Arya R
        • Wei G
        • McCoy JV
        • Crane J
        • Ohman-Strickland P
        • Eisenstein RM.
        Decreasing length of stay in the emergency department with a split emergency severity index 3 patient flow model.
        Acad Emerg Med. 2013; 20: 1171-1179
        • Sanchez M
        • Smally AJ
        • Grant RJ
        • Jacobs LM.
        Effects of a fast-track area on emergency department performance.
        J Emerg Med. 2006; 31: 117-120
        • Considine J
        • Kropman M
        • Kelly E
        • Winter C
        Effect of emergency department fast track on emergency department length of stay: a case-control study.
        Emerg Med J. 2008; 25: 815-819
        • Liu SW
        • Hamedani AG
        • Brown BFM
        • Asplin B
        • Camargo Jr., CA
        Established and novel initiatives to reduce crowding in emergency departments.
        West J Emerg Med. 2013; 14: 85-89
        • McGrath J
        • LeGare A
        • Hermanson L
        • Repplinger MD.
        The impact of a flexible care area on throughput measures in an academic emergency department.
        J Emerg Nurs. 2015; 41: 503-509
        • Wallingford Jr, G
        • Joshi N
        • Callagy P
        • Stone J
        • Brown I
        • Shen S.
        Introduction of a horizontal and vertical split flow model of emergency department patients as a response to overcrowding.
        J Emerg Nurs. 2018; 44: 345-352
        • Garrett JS
        • Berry C
        • Wong H
        • Qin H
        • Kline JA.
        The effect of vertical split-flow patient management on emergency department throughput and efficiency.
        Am J Emerg Med. 2018; 36: 1581-1584