Developing a Staff-Led Vertical Flow Model Policy in a Rural Emergency Department

Area of Science:

• Healthcare Management
• Emergency Medicine
• Process Improvement

Background:

• Emergency department overcrowding leads to longer wait times, increased mortality, and staff burnout.
• The vertical flow model, proven effective in large hospitals, reduces length of stay and patients leaving without being seen.
• Implementation of the vertical flow model has been limited in small, rural emergency departments.

Purpose of the Study:

• To develop a staff-led policy for a modified vertical flow model tailored to a small, rural emergency department.
• To assess emergency department staff perceptions of patient flow and identify areas for improvement.

Main Methods:

• An anonymous survey assessed staff perceptions of current patient flow.
• Survey data informed the development of a modified vertical flow model policy.
• The policy was reviewed and revised based on leadership feedback.

Main Results:

• 75% of staff rated current patient flow as suboptimal (3 or lower on a 5-point scale).
• Reducing door-to-provider time was identified as crucial for improving patient flow.
• Post-implementation, length of stay and rates of patients leaving without being seen decreased.

Conclusions:

• A modified vertical flow model, utilizing the waiting room and incorporating triage protocol orders, was successfully developed.
• The model was adapted and accepted by leadership in a small, rural emergency department setting.
• This demonstrates the successful adaptability of the vertical flow model for smaller, rural emergency departments.