Does sharing process differences reduce patient length of stay in the emergency department?

We assess the ability of the best demonstrated processes (BDP) methodology to decrease emergency department patient length of stay (LOS) in EDs in a large multihospital system.

Two hundred ninety-one EDs were ranked by LOS, and the fastest and slowest EDs were observed to identify the BDPs. The resulting "meaningful differences" were shared with all EDs throughout the hospital system. LOS studies were repeated after the BDP intervention. Five separate LOS measures were performed during a 19-month period, with 223 to 273 EDs participating in each measure. Three interval times were calculated: arrival to examination room, examination room to physician evaluation, and physician evaluation to discharge.

Two hundred ninety-one EDs participated, and 386,837 patient visits were evaluated. Before intervention, the average LOS was 147 minutes for all EDs and 186 minutes in the slowest third. At 19 months after intervention, the average LOS was 139 minutes for all EDs and 157 minutes in the slowest third. Between the initial and final measurement period, there was an 8-minute (5.4%) improvement in LOS on a system-wide basis, and the slowest third of EDs improved LOS by 29 minutes (15.6%). Before intervention, arrival to examination room time was 27 minutes, examination room to physician evaluation was 20 minutes, and evaluation to discharge was 100 minutes. After intervention, these times decreased to 22 (P <.001), 18 (P <.001), and 99 (P =.33) minutes, respectively. The slowest one third of EDs went from 37 to 24 minutes for arrival to examination room time (P <.001), from 25 to 20 minutes for examination room to evaluation time (P <.001), and from 124 to 113 minutes for evaluation to discharge time (P <.001).

Implementing observed BDP meaningful differences resulted in decreased patient LOS in EDs, particularly in the slowest one third of EDs in the hospital system.