Emergency departments are exploring various forms of throughput improvement, including changes to processes, staffing, technology and space utilization. The vertical flow model consists of changes to intake and bed assignment processes, as well as use of vertical treatment rooms. These rooms are smaller than a traditional emergency department room and feature a chair or assessment table, which keeps patients in a comfortable seated position.1 A vertical flow nurse practitioner assesses all patients, prescribes diagnostic tests and treatments, performs procedures, and formulates a diagnosis with discharge instructions, care plan, and patient education.
Vertical flow models are often implemented together with split-flow or fast-track models, and are used for ESI level 3 patients requiring testing, imaging and diagnostic care and cannot be quickly discharged, but also do not require critical care like patients at ESI levels 1 or 2.2 These patients can be placed in a mid-track vertical flow to a specialized ED space. In other ED throughput models, however, ESI level 3 patients are the lowest priority for ED bed assignment, and do not meet traditional fast track criteria. When applied to large hospitals, vertical flow models have been found to decrease length of stay for ESI level 3 patients at all operational hours.2
Vertical flow models have several benefits, one of which is that it can be implemented in coordination with the split flow model or with the traditional nurse-driven intake process. Second, vertical flows can be implemented with smaller financial costs compared to other throughput models, because it only requires repurposing of minimal space and supports higher patient volumes.2 Studies of vertical flow models note that patient privacy can be impacted due to high traffic, high density ED operations, but results are inconclusive in terms of impacts to patient satisfaction.
When paired with appropriate split flow models and aligned with intake procedures to capture mid-track ESI level 3 patients, vertical flow models show promising results for patient length of stay and satisfaction. They also benefit space-constrained emergency departments and support greater patient volumes without expanding geographic footprint, benefitting both the hospital and the larger communities.
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