Author Affiliations: Evangelical Community Hospital, Lewisburg, Pennsylvania (Dr Bennage and Ms Persing); Capstone College of Nursing, The University of Alabama, Capstone College of Nursing, Tuscaloosa, Alabama (Dr Ford); Department of Medicine, University of Mississippi Medical Center, The University of Alabama, Tuscaloosa, Alabama (Dr Ezemenaka).
Adv Emerg Nurs J. 2024;46(3):263-273. doi: 10.1097/TME.0000000000000525. Epub 2024 Aug 1.
This quality improvement initiative was conducted to determine if a provider in triage and split flow model could decrease the length of stay (LOS) of discharged patients seen in a community hospital emergency department (ED).
Extended LOSs within the ED lead to delays in the care of patients, increase the number of patients who leave without being seen by a provider, decrease patient satisfaction, and cause a loss of revenue for health care organizations. Using a provider in triage and a split flow model, where patients can be seen and dispositioned without delays, can improve ED throughput and decrease the overall LOS.
Through a structured, interdisciplinary approach using the Plan-Do-Study-Act Shewhart Cycle of Process Improvement, a provider was placed in triage, and an interior waiting room was used to evaluate emergency severity index level 3 and 4 patients to expedite diagnostic testing and perform procedures. This model allowed lower acuity patients to be cared for separately from higher acuity patients, who were being treated in the main ED. In addition, the median arrival to provider, arrival to bed, and LOS from arrival to departure of discharged patients were compared to the current departmental processes.
There was a significant improvement in the LOS of discharged patients and the time of arrival to triage, arrival to bed, and arrival to provider using a provider in triage and a split flow model compared to the current intake.
Implementation of a provider in triage and a split flow model can demonstrate a decrease in the LOS of discharged patients along with other ED metrics and improve efficiencies in patient care within a community hospital.
本质量改进计划旨在确定分诊和分流模式下的医护人员是否能够缩短社区医院急诊科（ED）出院患者的住院时间（LOS）。
ED 内 LOS 延长会导致患者的治疗延迟，增加未接受医护人员诊治的患者数量，降低患者满意度，并导致医疗机构收入损失。采用分诊和分流模式，使患者能够在不延误的情况下接受诊治和处置，可提高 ED 的吞吐量并缩短整体 LOS。
通过采用结构化的跨学科方法，利用计划-执行-研究-行动（Plan-Do-Study-Act）Shewhart 过程改进循环，在分诊处配备医护人员，并利用内部等候室评估紧急严重程度指数（ESI）3 级和 4 级患者，以加快诊断测试和实施程序。该模型允许将低严重程度患者与高严重程度患者分开治疗，高严重程度患者在主 ED 接受治疗。此外，将出院患者的到达医护人员时间、到达病床时间和 LOS 与当前部门流程进行了比较。
与当前的收治流程相比，采用分诊和分流模式配备医护人员后，出院患者的 LOS 和到达分诊时间、到达病床时间以及到达医护人员时间均有显著改善。
在社区医院实施分诊和分流模式下配备医护人员，可以证明其能缩短出院患者的 LOS，同时改善其他 ED 指标，并提高患者护理效率。
