Abstract
A quality improvement (QI) project was completed early in 2015 to evaluate the split
flow model of care delivery and a provider in triage model within a newly constructed
emergency department. The QI project compared 2 emergency departments of similar volumes,
one that splits the patient flow and employs a provider in triage model and the other
that blends the patient flow and employs a traditional nurse triage model. A total
of 68,603 patients were included in this project. The purpose of the split flow model
is to create a second flow stream of patients through the emergency department, parallel
to the regular acute/critical care flow stream, for patients with problems that are
not complex. Specific patient outcomes that were evaluated for the purpose of this
QI project were door to discharge or discharge length of stay (DLOS) for all ED patients.
The provider in triage model enhances patient triage assessment, as well as patient
flow within the emergency department, by allowing patients to be evaluated by an ED
provider immediately at the point of triage when the patient first presents to the
emergency department. The QI project demonstrated that the split flow model alone
reduced DLOS for all ED patients, and when coupled with the provider in triage model,
a greater reduction in DLOS, as well as an improvement in front-end throughput metrics,
was realized.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Emergency NursingAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Health, United States, 2012, with special feature on emergency care.(Published May 2013. Accessed February 4, 2016)
- Improving patient flow and reducing emergency department crowding: a guide for hospitals.(Published October 2014. Accessed February 4, 2016)
- Approved: standards revisions addressing patient flow through the emergency department.Jt Comm Perspect. 2012; 32: 1-5
- 2014 Clinical quality measures.(Updated September 24, 2015. Accessed February 4, 2016)
- Modeling the impact of changing patient flow processes in an emergency department: insights from a computer simulation study.Oper Res Health Care. 2013; 2: 66-74
- United States emergency department performance on wait time and length of stay.Ann Emerg Med. 2010; 55: 133-141
- Reliability and validity of a new five-level triage instrument.Acad Emerg Med. 2000; 7: 236-242
- 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
- Emergency department triage: a physician in triage (PIT) collaborative process.(Published July 24, 2014. Accessed February 4, 2016)
- The role of s split flow model in the improvement of emergency department efficiency with respect to patients presenting with different acuity levels.Ann Emerg Med. 2013; 62: S1-S2
- Impact of an expeditor on emergency department throughput.West J Emerg Med. 2011; 12: 198-203
- The future of emergency care in the United States health system.(Published June 2006. Accessed February 5, 2015)
Biography
Beth A. Pierce, Member, Greater Cincinnati Chapter, is Director of Emergency Services, Mercy Health West Market, Cincinnati, OH.
Biography
Denise Gormley is Associate Professor and Executive Director, Graduate Programs, and Coordinator, Nursing Administration Program, University of Cincinnati, Cincinnati, OH.
Article info
Publication history
Published online: April 26, 2016
Identification
Copyright
© 2016 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.
