Improving stable patient flow through the emergency department by utilizing evidence-based practice: one hospital's journey.

Many patients utilize hospital emergency services for non-emergent care. The lack of access to primary care providers, lack of insurance, and lack of information about when to use the emergency department have contributed to the crowding of emergency departments with non-emergent cases. Crowding has created longer wait times and an increased number of people leaving without a medical screening examination. Studies suggest a growing need to improve patient flow through the emergency department and to maximize resource utilization. Through a patient flow improvement project, this organization identified internal benchmarks related to total length of stay for stable patients presenting to the emergency department to promote early intervention and rapid treatment. In an attempt to meet internal as well as national benchmarks related to total length of stay, a satellite area where stable patients could be treated in a timely manner was created. One identified need was the development of a protocol that addressed the timely staffing of the satellite area to improve stable patient flow. A volume-driven protocol was developed and implemented through the use of published evidence focused on essential endpoints of measurement. The process used for the development, implementation, and evaluation of the protocol was the Iowa Model of Evidence-Based Practice.