A new study published in the INFORMS journal Management Science found that a data-driven triage protocol reduced emergency department length of stay by 11 minutes without compromising patient safety or requiring additional resources, according to research released on Jul. 28.
Researchers from Harvard University, Oxford University, and Mayo Clinic developed an evidence-based protocol to identify patients who could safely receive care in a seated treatment area—known as a vertical processing pathway—instead of occupying a traditional emergency department bed. The approach aims to address the persistent challenge of long wait times in emergency departments without expanding facilities or increasing staff.
The team analyzed nearly 50,000 emergency department visits at Mayo Clinic Arizona to develop a machine learning model that predicts whether a patient will ultimately require an emergency department bed using only information collected during triage. These predictions were combined with mathematical models of patient flow to determine the most efficient routing strategy and then translated into a straightforward decision tree for clinicians. The researchers conducted a 13-week prospective field trial involving 11,015 patients at Mayo Clinic Arizona's new emergency department to evaluate the protocol.
The protocol uses information already collected during triage—including Emergency Severity Index score, presenting complaint, and whether the department is over capacity—and does not require additional staff, equipment, or software integration. "Our findings show that improving patient flow doesn't always require expanding capacity," said Soroush Saghafian, co-author of the study and professor at Harvard University. "Sometimes the greatest opportunity comes from using existing resources more intelligently."
According to estimates by the researchers, a medium-sized emergency department treating approximately 40,000 patients annually could recover nearly 6,800 bed-hours each year—enough capacity for roughly 2,000 additional patients and potentially generating about $3 million in additional reimbursement—all without facility expansion or increased staffing.
Emergency department overcrowding has been an ongoing issue for hospitals nationwide. The researchers believe their findings demonstrate that operational improvements grounded in analytics and implemented through simple clinical protocols can yield meaningful gains without sacrificing quality of care.
