Dissertation
Implementation of a Split Flow in the Emeregency Department
University of Iowa
Doctor of Nursing Practice (DNP), University of Iowa
Spring 2025
Abstract
Background: Emergency departments (EDs) across the country face increasing challenges from non-emergent cases, leading to overcrowding, long wait times, decreased staff satisfaction, and higher rates of patients leaving without being seen (LWBS). A community-based Midwest hospital saw a 20% increase in daily patient volume post-pandemic, with a majority presenting for non-emergent issues. Evidence supports using a split-flow to create alternative patient pathways at triage to increase patient satisfaction and decrease the length of stay for discharged patients. Purpose: This quality improvement project aimed to decrease LWBS, reduce the length of stay (LOS) for Emergency Severity Index (ESI) level 4 and 5 patients, and improve provider satisfaction. Methods: The Plan-Do-Study-Act (PDSA) framework was used to design, implement, and evaluate the intervention. A split-flow model was introduced to reroute low-acuity patients to a designated area for faster evaluation and treatment. Staff were educated with electronic information. Data were collected from September 2024 to January 2025 through EPIC SlicerDicer and compared to the same period in the prior year. This included 14,415 patients in total, and 3600 were ESI level 4. Staff satisfaction was measured via post-implementation surveys. Findings: The split-flow model resulted in a 0.08% (23 patients) overall reduction in LWBS rates. There was an average of 7 7-minute decrease in visit time, one month saw a 26-minute decrease. Staff feedback indicated that while only 50% felt it improved patient flow, 80% believed the process was necessary. Discussion: Although the project didn t fully achieve its targets, the partial improvements and insights gathered suggest that a split-flow process holds promise in enhancing ED efficiency and patient care. Limitations included inconsistent staff training, limited physical space, and provider resistance to changing workflows. Future efforts should prioritize infrastructure improvements and staff education to support sustainable change. Overall, the project highlighted the value of targeting lower-acuity patient flow to reduce ED congestion, improve satisfaction, and increase the recovery of lost revenue.
Details
- Title: Subtitle
- Implementation of a Split Flow in the Emeregency Department
- Creators
- Kimberly Copeland - University of Iowa
- Contributors
- Mary Dirks (Chair) - University of Iowa
- Resource Type
- Dissertation
- Project Type
- Poster
- Degree Awarded
- Doctor of Nursing Practice (DNP), University of Iowa
- Degree in
- Family Nurse Practitioner
- Date degree season
- Spring 2025
- Publisher
- University of Iowa
- Number of pages
- 1 page
- Copyright
- Copyright 2025 Kimberly Copeland
- Language
- English
- Academic Unit
- College of Nursing; Doctor of Nursing Practice Projects
- Record Identifier
- 9984841528302771
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