A split-flow model for ED level 3 patients

Abstract

<p><strong>Purpose:</strong> Prolonged wait times and length of stays have inundated Emergency Departments(ED) across the nation. Our ED has struggled with these same hurdles over the past few years. Specifically, patients that are assigned emergency severity index (ESI) level 3 have overwhelmed our department by increasing wait times and length of stays (LOS). Therefore, the purpose of this project was to implement a method to decrease the level 3 emergency department discharged patients&rsquo; LOS. A secondary purpose was to reduce our left without being seen (LWBS) level 3 patients.</p> <p><strong>Design:</strong> This is a quality improvement project that was conducted over a two month period beginning in October&nbsp; and carried through November 2016.</p> <p><strong>Setting:</strong> The project took place at our level one trauma ED located in a academic teaching facility in Central Texas.&nbsp; Our ED is a 44 bed unit.</p> <p><strong>Participants/Subjects:</strong> Between October and November our total number of patients seen was 9709 of which 4781 were level 3 patients. Inclusion criteria was ESI level 3&nbsp; patients that could be evaluated in a fast track area requiring three of more interventions such as: labs, imaging, or medications.&nbsp; Our exclusion criteria was level 3 patients with multiple comorbidities requiring a more complex evaluation in an ED room and likely requiring hospital admission.</p> <p><strong>Methods:</strong> A designated nurse and physician was assigned to run a level 3 focused fast track (FFT) in conjunction with the existing fast track that was managed by advanced practice providers.&nbsp; Physicians reviewed triage notes and vital signs to decide whether the patient met criteria for our focused fast track. Patients were then escorted to FFT room where standing orders/interventions were performed and a focused assessment by physician and nurse completed. FFT patients taken to pending results area to await completed results. Patient was than either discharged or placed in an ED room for further evaluation.</p> <p><strong>Results/Outcomes:</strong>&nbsp; Our pre-intervention average LOS for level 3 patients was 262 minutes. Upon implementation of our project the average decreased to 161 minutes. In addition, our LWBS decreased and patient satisfaction scores increased. As supported by a 25% reduction in wait times and LOS for level 3 patients.</p> <p><strong>Implications:</strong> Level 3 patients were systemically and efficiently processed which decreased LOS. Additionally, the decreased LOS contributed to increased patient and staff satisfaction due to decreased workload to the department.&nbsp; There is a cost savings related to LWBS ($2,000/patient) patients. The average from January to September was 4.33%. LWBS average for October decreased further to 2.44%.&nbsp; November LWBS decreased to 1.63%.</p>