Use split-flow approach to speed patients to needed care, eliminate inefficiencies and duplication.

To address time and space challenges in the midst of surging demand, the ED at St. Mary Medical Center in Langhorne, PA, turned to the split-flow model, an evidence-based practice that relies heavily on the queuing theory to improve patient throughput. In less than one year, the approach has enabled administrators to reduce door-to-physician times from an average of 47 minutes to 23.5 minutes, and overall length-of-stay in the ED for discharged patients has been slashed by 21 minutes. Under the split-flow system implemented at St. Mary, an expedited triage/assessment process directs patients to prompt care, pediatric care, acute care, or an expedited treatment area (ETA) where patients will undergo further testing or procedures. This initial assessment typically takes about three minutes. Patients sent to the ETA remain there for no longer than 30 minutes.They may then be moved to a holding area while awaiting test results. Patients are constantly moving in the split-flow model, so it is important to pay close attention to handoffs. Patients will begin the process with one nurse and finish with another.