How Northwell Health redesigned 2 of its EDs to drive efficient workflow


 Some U.S. hospitals and health systems are turning to architecture to improve operational workflow and patient satisfaction.

One potential architectural redesign involves the deployment of the "split flow model." Under the model, emergency department patients are greeted by a "pivot nurse" who conducts an initial assessment of the patient and directs them to specific intake rooms to be seen by a provider. The model aims to reduce bottlenecks and decompress the ED, allowing high- and low-acuity patients access to the care they need more efficiently.

In an effort to improve operational workflow at its facilities, New Hyde Park, N.Y.-based Northwell Health partnered with the New York City office of CannonDesign, a global architecture, engineering and design firm, to redesign two of its EDs at Huntington (N.Y.) Hospital and Southside Hospital in Bay Shore, N.Y., using the split flow model.

John D'Angelo, MD, executive director and senior vice president for emergency medicine at Northwell Health, told Becker's Hospital Review the health system spent nearly six years experimenting with various practices to optimize workflow. He said his team and the CannonDesign team opted for the split flow model because it allows the majority of low- and moderate-acuity patients to be assessed by a provider much quicker than the traditional ED format allows. For example, a patient's insurance information is recorded almost immediately once he or she enters the ED. This allows front-line staff to process the individual's information faster, Dr. D'Angelo noted.

The lower-acuity side of the split flow model, which Northwell Health refers to as the "super-track ED," features a mix of open treatment bays and flexible treatment rooms, sub-waiting areas and vertical waiting patient positions and interview and consultation rooms all organized around a central team station, Robert Masters, a principal in the health practice for CannonDesign, told Becker's Hospital Review. The positioning of the super-track ED allows the care team to efficiently move their lower-acuity patients through the steps of their visit and manage their patient experience by keeping them out of higer-acuity clinical areas of the ED, Mr. Masters said.

Dr. D'Angelo said the redesign has led to improvements in the rate at which patients are seen by providers, and there has been a "significant drop" in the number of patients who leave the ED prior to being evaluated by a provider. However, Dr. D'Angelo said to satisfy patients' expectations, the health system must focus its attention on various other factors besides how quickly care is delivered.

"Patient experience is driven by a number of things. One of them is how well we deliver the care, not just the quality or the manner in which we interact with folks," Dr. D'Angelo said. "This project allowed us to think about the differing expectations between patients walking into the ED with a moderate- or lower-acuity complaint versus the expectations of patients coming in out of an ambulance and respond to each within the context of the specific care setting."

Mr. Masters said the redesign proved to be successful, in part, because of the collaboration between Northwell, CannonDesign and the front line staff directly overseeing the redesigned facilities.

"From a patient experience perspective, we designed a mix of spaces to treat those lower- and moderate-acuity patients as efficiently as possible to manage their length of stay [at both facilities.] … [We] also [aimed to] give staff the support they need to operate at a high level."


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