North Texas Research Forum 2024



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North Texas


Medical City Arlington


Emergency Medicine

Document Type


Publication Date



Emergency Medicine | Medicine and Health Sciences | Quality Improvement


Background: Crowding in the emergency department has been a prevalent issue for decades, however, over the last few years, crowding and the number of patient visits in EDs have been higher than normal. Many factors influenced this, including the COVID-19 pandemic. Emergency departments around the country have been at a loss in improving patient flow and time in the ER. Literature has demonstrated some possible methods with varying results, but there has not been significant research on the subject. Methods: After reviewing the literature, we designed a system where patients were stratified between different groups using the triage system. If patients met any of the exclusion criteria as described, patients were placed in rooms. If the patients met the inclusion criteria, they were placed in the vertical zone, and the patient was then seen by a nurse and a provider. After placing orders, the patient was then moved to the waiting room. After this was done for 1 year the patient length of stay times (discharge/admission) were compared before and after the implementation of the vertical zone. Statistical analyses were performed calculating t and p values. Results: The study included 33,949 patients with general demographics including age, sex, and group (vertical zone vs normal triage system) and evaluated multiple time factors for their stay. Patient volume remained the same compared to the previous year. The average low acuity length of stay was noted to decrease from 81.45 minutes to 71.64 minutes, a difference of 10 minutes (p=.05). The overall discharge length of stay was reduced from 158 minutes to 141 minutes (p=.04). There was no statistical difference between the average arrival to greet time, 6 minutes before the implementation and 5.5 minutes after the implementation. The average length of stay for admitted patients also significantly decreased from 315 minutes to 243 minutes (p=.0006). Conclusion: In summary, by implementing this vertical zone redesign at our facility, low-acuity patient times were shortened by 10 minutes. The overall disposition time was shortened by 15 minutes to discharge over 11 months. This means that by continuing this practice in the future, patient's length of stay will decrease and patient flow will become more efficient overall. This study has provided tangible data on changing overall practice in respective hospitals now and in the future.

Original Publisher

HCA Healthcare Graduate Medical Education

Impact of Vertical Zone Redesign: One Hospitals Experience



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