Improving Emergency Department Boarding Time: Balancing Efficiency and Safety

Area of Science:

• Healthcare Operations
• Quality Improvement Science
• Patient Flow Management

Background:

• Emergency department (ED) crowding and prolonged boarding times significantly impair patient care quality.
• Inefficiencies in the patient admission process contribute to extended ED boarding.
• Optimizing patient transitions from ED to inpatient (IP) units is crucial for healthcare delivery.

Purpose of the Study:

• To decrease average ED boarding time for admitted patients by 35% over 24 months.
• To identify and address systemic inefficiencies in the ED-to-IP admission process.
• To improve overall patient flow and care access within the hospital system.

Main Methods:

• Utilized the Model for Improvement framework and a key driver diagram to guide interventions.
• Implemented serial Plan-Do-Study-Act (PDSA) cycles for iterative testing and refinement of process changes.
• Focused interventions on enhancing shared process knowledge, IP room readiness, stakeholder communication, and admission streamlining.
• Employed statistical process control charts to monitor ED boarding time, ED length of stay (LOS), very rapid transfer rate, and left without being seen (LWBS) rate.

Main Results:

• Achieved a 40% reduction in average ED boarding time, decreasing it from 169 to 102 minutes.
• Observed a concurrent decrease in ED length of stay (LOS) and left without being seen (LWBS) rates.
• Maintained stability in the very rapid transfer rate, indicating no adverse impact on critical care access.

Conclusions:

• Sustained engagement from institutional and site leadership was critical for project success.
• A systematic approach to understanding and optimizing the admission process led to significant improvements.
• Streamlined communication and clear process timelines effectively improved transitions of care and ED operations.