ED Throughput Overview

The National Public Health and Hospital Institute (NPHHI) received a generous grant from The Commonwealth Fund in 2008 to conduct a study entitled “Safety Net Hospitals and Emergency Department Throughput: Best Practices from High Performers.” In partnership with the University HealthSystem Consortium and with guidance from an advisory group comprised of NAPH member hospitals, NPHHI developed an emergency department (ED) cycle time survey to capture performance data relevant to ED throughput. NPHHI administered the survey, analyzed the data, and conducted follow-up interviews with administrators at facilities that ranked as “high performers” (i.e., those scoring in the top 25th percentile on key metrics, including length of stay and time to admittance). The project enabled NPHHI to identify the most effective ED patient flow strategies employed by safety net hospitals.

The survey findings, which will be released later this year, identified five major categories of strategies used by top performing safety net hospitals to improve patient flow in the ED:

1. Triage redesign (e.g., creating a rapid assessment process, establishing triage protocols, adding additional staff); 
2. Alternatives to treating patients in the main ED (e.g., creating a rapid treatment area, creating/expanding a “fast-track” or express care area); 
3. ED operational changes (e.g., expanding ED resources, such as beds or clinical staff, adding an ED flow coordinator position, introducing new technologies); 
4. Changing how patients are admitted from the ED (e.g., creating additional treatment spaces outside of the ED for admitted patients, assigning boarder patients to non-ED staff, adding hospitalists); and 
5. Hospital-wide strategies to streamline patient flow (e.g., establishing a surge capacity protocol, centralizing bed management, holding daily multidisciplinary bed meetings, promoting early discharge).