HKS Authors

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Background: Although many emergency departments (EDs) employ some form of vertical patient flow, there is limited published literature describing variations of vertical pathways. Objectives: We sought to describe our ED's emergency physician (EP)-driven vertical model and to characterize patients selected by EPs to be seen in our vertical space. Methods: We retrospectively reviewed all vertical ED encounters in the study period, separately analyzing those who eventually received an ED bed (“ED Bed”) and those who were discharged without being roomed (“Vertical only”). We report patient demographics, ESI, vital signs, oxygen use, chief complaints, resource utilization, ED LOS, disposition, and 72 h return rates. Results: Physicians elected to perform initial evaluations of a variety of patients in the vertical space. The two most common classes of complaints evaluated in the vertical space were extremity issues (21.4%) and skin complaints (13.5%). Patients presenting with abdominal pain and chest pain initially assessed in vertical were significantly more likely to later receive an ED bed (Standardized Difference of 38% and 21.4% respectively), and patients with skin complaints were more frequently discharged from the vertical space and were less likely to receive an ED bed


Hodgson, Nicole R., Soroush Saghafian, Molly C. Klanderman, Andrej Urumov, Stephen J. Traub. "Physician-Driven Early Evaluation: Encounters Seen in a Vertical Model." Journal of Emergency Medicine Reports 2.2 (June 2023): 100028.