How We Implemented A Split Flow Hallway.

Area of Science:

• Emergency Medicine
• Healthcare Operations
• Patient Safety

Background:

• Emergency department (ED) hallway spaces (HS) are increasingly used during overcrowding, posing risks to patient safety, privacy, and equity.
• High patient volume and acuity at Duke University Hospital (DUH) ED led to frequent HS use for active treatment, with safety reports highlighting issues with critically ill patients in HS.
• Existing vertical split flow (VSF) strategies improve throughput but safety-focused hallway interventions remain underreported.

Purpose of the Study:

• To implement and evaluate standardized hallway space (HS) workflows to mitigate safety, privacy, and equity risks.
• To improve patient care delivery in ED hallway spaces through systematic interventions.
• To assess the impact of standardized workflows on patient acuity and disposition in HS.

Main Methods:

• A multidisciplinary team implemented standardized HS workflows using iterative Plan-Do-Study-Act cycles.
• Interventions included standardized staffing, patient selection criteria, remote monitoring, privacy enhancements, and VSF principles applied to hallway operations.
• A retrospective analysis of 11,602 adult patient encounters in HS over 53 weeks was conducted.

Main Results:

• Patients in vertical hallway spaces (HS) were less likely to be high-acuity (IRR 0.68) and less likely to be admitted (IRR 0.30) compared to those in horizontal HS.
• No hallway space-related safety reports occurred during the intervention period.
• Standardized workflows and patient selection criteria were successfully implemented for continuous HS utilization.

Conclusions:

• Standardized hallway workflows and specific patient selection criteria effectively operationalized hallway spaces for continuous use.
• These interventions significantly reduced the exposure of high-acuity patients to hallway care.
• The study demonstrates a successful strategy for enhancing safety and efficiency in overcrowded emergency departments.