Emergency Department Setting

  • Suburban community hospital
  • 59,000 annual ED visits
  • 33 ED beds
  • Level III Trauma Center


  • Decrease left without being seen (LWBS) rate by providing patients with a face-to-face
    evaluation with the provider within 30 minutes of arrival
  • Key Concepts
  • Door-to-provider time is the number one patient satisfaction driver
  • “Excellent” threshold is less than 30 minutes, with best ED practice nationally at 15 min


  • 12-hour APP shift in triage from 10 a.m. – 10 p.m. to do rapid medical evaluations
    during busiest time
  • Medical Director to direct ED physicians and APPs to transition from reactive to
    proactive problem solving
  • Review process flow chart and make adjustments to expedite the patient to physician
    encounter with decrease in waits and delays. Any impediments to this encounter to be
    reduced or eliminated and be embraced by all ED staff. Remove waste in the flow.
  • Understand that Process Improvement is a team effort (Medical Director, Nurse
    Manager, Head Registration Clerk, Head Technician), and work accordingly with
    same minded-goal
  • Provide in-service training for ED staff and provide up-to-date articles to physicians


  • Successfully achieved the goal of seeing patients in less than 30 minutes of arrival
  • Reduced throughputs
  • Reduced LWBS