Emergency Department Door to Discharge Times

Efficient emergency medical care is becoming more important with continually increasing emergency department volumes. Decreasing door to discharge (D2D) times has been shown to improve patient satisfaction and decrease wait times and health care costs. We hypothesize that standardized onboarding for new faculty physicians in microhospital emergency departments will reduce D2D times.

In this retrospective observational study, D2D times were tracked for newly hired physicians at 2 microhospital emergency departments within an academic health system during 2021-2022. Physicians hired after July 2022 received an onboarding process that emphasized reducing D2D times. D2D times for these physicians were compared with those of physicians hired earlier who did not receive any onboarding. D2D means and standard deviations (SD) of each group were compared with 2-sample t tests.

There were 25 newly hired emergency department physicians across both study locations over 2 years; 15 received no onboarding, while 10 received onboarding. At one of the emergency departments, physicians who received onboarding had a significantly reduced mean D2D time compared with those who received no onboarding (119 minutes [SD = 29] vs 146 minutes [SD = 34], P = 0.049). At the other emergency department, there was no significant difference in D2D times between physicians who did or did not receive onboarding (97 minutes [SD = 35] vs 102 minutes [SD = 30], P = 0.760). Across both locations, physicians who received onboarding had a nonsignificant reduction in D2D times compared with those who received no onboarding (110 minutes [SD = 32] vs 126 minutes [SD = 39], P = 0.160).

After implementing an onboarding process for new physician hires, there was a statistically significant decrease in D2D times at one of the microhospital emergency departments. Thus, an onboarding process may represent a simple, cost-effective technique that emergency departments can use to reduce D2D times and prevent overcrowding. Future work may evaluate the efficacy of such processes in non-microhospital emergency department settings.