Dartmouth Events

Evaluation of a Split Flow Model for the Emergency Department

Engineering Jones Seminar with Gabriel Zayas-Cabán, Professor of Industrial and Systems Engineering, U Wisconsin-Madison

Friday, January 13, 2023
3:30pm – 4:30pm
Spanos Auditorium, Cummings Hall
Intended Audience(s): Public
Categories: Lectures & Seminars

Optional ZOOM LINK
Meeting ID: 942 6912 4921
Passcode: 701201

Split flow models, in which a physician rather than a nurse performs triage, are increasingly being used in hospital emergency departments (EDs) to improve patient flow. Before deciding whether such interventions should be adopted, it is important to understand how split flows causally impact patient flow and outcomes. We employ causal inference methodology to estimate average causal effects of a split flow model on time to be roomed, time to disposition after being roomed, admission decisions, and ED revisits at a large tertiary teaching hospital that uses a split flow model during certain hours each day.

We propose a regression discontinuity (RD) design to identify average causal effects, which we formalize with causal diagrams. Using electronic health records data (n = 21,570), we estimate that split flow increases average time to be roomed by about 4.6 minutes (95% CI: [2.9,6.2] minutes) but decreases average time to disposition by 14.4 minutes (95% CI: [4.1,24.7] minutes), leading to an overall reduction in length of stay. Split flow is also found to decrease admission rates by 5.9% (95% CI: [2.3%, 9.4%]) but not at the expense of a significant change in revisit rates. Lastly, we find that the split flow model is especially effective at reducing length of stay during low congestion levels, which mediation analysis partly attributes to early task initiation by the physician assigned to triage. 

For more information, contact:
Amos Johnson

Events are free and open to the public unless otherwise noted.