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Updated: Dec 21, 2025

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A Front-end Redesign With Implementation of a Novel "Intake" System to Improve Patient Flow in a Pediatric Emergency

Kevin P Carney1, Ann Crespin2, Gray Woerly2

  • 1Department of Pediatrics, Section of Emergency Medicine, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colo.

Pediatric Quality & Safety
|May 20, 2020
PubMed

Insights

A pediatric emergency department improved patient flow by redesigning front-end processes. This initiative significantly reduced wait times and the rate of patients leaving without being seen, enhancing overall care.

Area of Science:

  • Pediatric Emergency Medicine
  • Healthcare Quality Improvement
  • Lean Management

Background:

  • Children's Hospital Colorado's emergency department (ED) faced challenges with increasing patient volumes, leading to extended wait times and high left-without-being-seen (LWBS) rates.
  • In 2015, the median door-to-provider time was 49 minutes, and the LWBS rate was 3.2%.
  • The ED leadership set goals to reduce median door-to-provider time to under 30 minutes and the LWBS rate to below 1%.

Purpose of the Study:

  • To improve patient flow within a high-volume pediatric emergency department.
  • To decrease door-to-provider times and reduce the rate of patients leaving without being seen.

Main Methods:

  • An inter-professional team applied quality improvement and Lean methodology to redesign ED front-end processes.
  • Key changes included implementing Flow Nurse/EMT roles, eliminating traditional registration/triage, introducing quick registration and nurse assessment, direct-bedding, and a novel physician-led Intake system.

Main Results:

  • The median door-to-provider time decreased by 49% to 25 minutes.
  • The LWBS rate decreased by 56% from 3.2% to 1.4%.
  • Improvements were also observed in the percentage of patients seen within 30 minutes, overall ED length-of-stay, and patient satisfaction.

Conclusions:

  • Redesigning front-end processes and implementing a pediatric emergency medicine-led Intake system effectively reduced door-to-provider times and LWBS rates in a large pediatric ED.
  • Quality improvement and Lean methodology were instrumental in achieving these patient flow enhancements.
Abstract

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