Researchers from Mayo Clinic, Harvard University and Oxford University created a decision tree to identify patients who can receive treatment while sitting instead of requiring a bed — reducing length of stay and increasing ED efficiency without adversely affecting outcomes or care quality.
The study, published July 9 in Management Science, created a decision tree based on mathematical and machine learning models to help staff determine which patients require a bed or could be directed to a vertical processing pathway. Currently, the decision to treat patients while sitting is “made in an ad-hoc fashion,” the study authors wrote.
The bed-free approach was tested at Phoenix-based Mayo Clinic Arizona’s emergency department. Researchers found it cut length of stay by 4.2%, or 11 minutes, without adversely affecting quality of care or outcomes. The strategy also cost $0 to implement since it used the capacity and clinicians already present.
“This effect was statistically significant and remained robust after controlling for various confounding factors and potential sources of endogeneity,” the study authors wrote. “Our vertical processing pathway protocol can also be utilized in other EDs, offering operational improvements without requiring additional resources.”
