Improving Utilization of Split Flow for Patients Assigned an Emergency Severity Index® Level of 3 in a Community Emergency Department: A Quality Improvement Project

A quality improvement project was conducted to identify if a site-specific split flow (SF) guide provided to triage nurses would decrease the length of stay (LOS) and rates of leaving without being seen (LWBS) in patients assigned an emergency severity index® (ESI) of 3 in a 16-bed community emergency department (ED). Emergency department overcrowding leads to delays in care and patient and staff safety concerns, especially in a resource-limited environment. As a result of overcrowding, patient LOS and rates of LWBS are increasing. ESI® 3 patients are the most affected population by decreased ED throughput. A SF model already exists in this ED but with poor utilization. Improved utilization can improve ESI® 3 patient throughput.A pre- and post-analysis was conducted over a 20-week project period, where a SF triage reference for ESI® 3 patients was introduced. The tool included ESI® 3 triage criteria, SF exclusion criteria, a site-specific flowchart for assignment of patients to care areas, and special considerations. This reference allowed for identification of ESI® 3 patients that could be treated within SF or assigned to traditional ED care. There was no significant improvement in LOS or LWBS for ESI® 3 patients during the project period but there was a clinically significant improvement in throughput for ESI® 3 patients. Further examination is needed for long-term improvement in utilization of SF at this site.