Implementing a Vertical Flow Model with Nurse Practitioners in the Emergency Department

Abstract Emergency department crowding is known to negatively impact patient length of stay and emergency department throughput. Due to increased patient volumes over a 4-year period and a stable volume of patient seen in the triage treatment area, an academic pediatric level 1 trauma center in Philadelphia, Pennsylvania identified the vertical flow model as a method to improve efficiency within the emergency department. A multidisciplinary team implemented a sub-wait area within the emergency department to initiate interventions with a criteria for pediatric patients. This quality improvement project was implemented for a 10-week period during the high volume season. Outcome metrics include length of stay for discharged emergency severity index level 4 and 5 patients and the percentage of patients treated in the triage area. During the 10-week time period, there was an increase in the percentage of patient seen in the triage area from 12% to 16%. The median length of stay for discharged ESI 4/5 patients decreased 18 minutes from 138 minutes pre-intervention to 120 minutes post-intervention. The vertical flow model demonstrated improvement in emergency department throughput and patient length of stay through the implementation of interventions upon arrival to the emergency department. Using patient criteria to initiate care allowed for a higher volume of patients to be cared for in the triage area.