Improving Emergency Department Throughput Through Implementation of Split Flow

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Emergency Departments represent a major point of entry to the healthcare system. The lack of timely primary care options results in referrals to the ED for primary and specialty care, and EDs serve as important safety net protections for immigrants and those without health insurance. The federal government requires EMTALA mandatory medical screening for all patients which leads to a constant, often overwhelming, influx of patients in busy EDs. This project focused on improving throughput for low acuity patients who frequently experience delays in care and increased frustration because of the need for ED staff to prioritize care for higher acuity patients. A Kaizen group assessed the challenges of a patient from entry to first provider contact and recommended implementation of split flow as a strategy to decrease door to doctor time, left without being seen rates, and improvements in patient satisfaction scores.

Door to doctor time, left without being seen, and patient satisfaction scores were measured prior to and three months post-implementation of split flow. For door to doctor time, the results showed a sharp decline to 11 minutes. Door to doctor times during peak hours before split flow implementation improved and remained below door to doctor times during non-peak hours after implementation. The LWBS rate decreased to less than 1%; however, this improvement was not sustained. Patient satisfaction scores showed no improvement over baseline after split flow implementation. Split flow implementation is a successful implementation strategy to expedite front-end operations. This strategy was very effective during the Covid-19 surge and is now embedded in the Emergency Management plans for the management of low acuity patients in the event of future disasters.



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