Study Finds Bed-Free Care Pathway Improves ED Flow

Emergency department (ED) overcrowding is a common challenge for health systems across the U.S. One factor that contributes to delayed treatment is the limited number of beds available in EDs. As a result, adopting an innovative care delivery approach — identifying patients who can receive treatment while sitting rather than lying down — can reduce length of stay and increase ED efficiency without any adverse impact on outcomes or care quality, according to a study published in the journal Management Science.

How a Bed-Free Vertical Processing Pathway Reduces Emergency Department Overcrowding and Improves Patient Flow

Researchers from Mayo Clinic, Harvard University and Oxford University developed a simple decision tree based on mathematical and machine learning models to help ED staff determine whether patients require beds or can be directed to a “vertical processing pathway,” an area where patients receive medical attention while sitting. Many hospitals already have those areas but lack a system for identifying candidates for vertical treatment.

The researchers tested the innovative approach at the Mayo Clinic Arizona emergency room in Phoenix and found that it produced an 11-minute or 4.2% decrease in length of stay without adversely affecting quality-of-care outcomes. The strategy is also affordable ($0 to implement at the Mayo Clinic Arizona ED) because it doesn’t require hospitals to add capacity or employ more clinicians.

While an 11-minute reduction in length-of-stay might not seem significant, it can make a noticeable difference in the emergency department. In fact, study co-author Agni Orfanoudaki, an associate professor of operations management at the University of Oxford’s Saïd Business School, told U.S. News and World Report that the impact of the protocol was so surprising that the central Mayo Clinic operations team called the ED after noticing the increase in efficiency and asked what they were doing to improve operations.

The Bottom Line for Hospitals and Health Systems

Improving care delivery doesn't have to involve expensive, complicated or high-tech solutions. This relatively simple vertical processing pathway protocol can have a considerable impact on ED bottlenecks.