Improving door-to-physician times in 2 community hospital emergency departments

Door-to-physician time in the emergency department (ED) correlates with patient satisfaction and clinical quality and outcomes. Delays in seeing a provider result in a 3% nationwide rate of patients leaving without being seen (LWBS) after presenting for ED care. Two community hospitals had door-to-physician times of 51 and 47 minutes. The LWBS rates were 3% and 2%. A quality improvement project was initiated with a change package, including prompts, training, and feedback. Door-to-physician times decreased to 31 and 27 minutes. The change occurred in less than a month and was sustained for 6 months after the study. In addition, the LWBS rates at each facility fell by one third. Basic process improvement strategies borrowed from service industries were used in 2 EDs to improve the door-to-physician process.