Abstract
Introduction
ED overcrowding is an issue that is affecting every emergency department and every
hospital. The inability to maintain patient flow into and out of the emergency department
paralyzes the ability to provide effective and timely patient care. Many solutions
have been proposed on how to mitigate the effects of ED overcrowding. Solutions involve
either hospital-wide initiatives or ED-based solutions. In this article, the authors
seek to describe and provide metrics for a patient flow methodology that targets ESI
3 patients in a vertical flow model.
Methods
In the Stanford Emergency Department, a vertical flow model was created from existing
ED space by removing fold-down horizontal stretchers and replacing them with multiple
chairs that allowed for assessment and medical management in an upright sitting position.
The model was launched and sustained through frequent interdisciplinary huddles, detailed
inclusion and exclusion criteria, scripted text on how to promote the flow model to
patients, and close analytics of metrics. Metrics for success included patient length
of stay (LOS) for those triaged to the vertical flow area compared with ESI 3 patients
triaged to the traditional emergency department as a comparison group. The secondary
outcome is the total number of patients seen in the vertical flow area. This was a
6-month—September 2014, to February 2015—retrospective pre- and postintervention study
that examined LOS as a marker for effective launch and implementation of a vertical
patient workflow model.
Results
The patients triaged to the vertical flow area in the study period tended to be younger
than in the control period (43 years versus 52 years, P = 0.00). There was a significant decrease in our primary end point: the total LOS
for ESI 3 patients triaged to the vertical flow area (270 minutes versus 384 minutes,
P = 0.00).
Conclusion
Implementation of a vertical patient flow strategy can decrease LOS for the vertical
ESI 3 patients based upon the inclusion and exclusion criteria. Furthermore, this
is accomplished with minimal financial investment within the physical constraints
of an existing emergency department.
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References
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Biography
Gregory Wallingford Jr is Emergency Medicine Resident, Stanford University Department of Emergency Medicine, Palo Alto, CA.
Biography
Nikita Joshi is Clinical Instructor, Stanford University of Emergency Medicine, Palo Alto, CA.
Biography
Patrice Callagy is Director of Emergency Services, Stanford University Department of Emergency Medicine, Palo Alto, CA.
Biography
Jamie Stone is Assistant Patient Care Manager, Stanford University Department of Emergency Medicine, Palo Alto, CA.
Biography
Ian Brown is Clinical Assistant Professor, Stanford University Department of Emergency Medicine, Palo Alto, CA.
Biography
Sam Shen is Medical Director, Emergency Medicine and Clinical Associate Professor, Stanford University Department of Emergency Medicine, Palo Alto, CA.
Article info
Publication history
Published online: November 20, 2017
Footnotes
Earn Up to 6.0 CE Hours. See page 438.
☆The data in this article were presented at the Institute for Healthcare Improvement (IHI) Conference in December 2016.
Identification
Copyright
© 2017 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.
