Emergency Department Flow Updates Help Patients Get Safe, Efficient Care (2024)

Emergency Department Flow Updates Help Patients Get Safe, Efficient Care

Keep Me Safe is the first and foremost of AdventHealth’s Service Standards. This commitment allows us to continually work to ensure the safety of people in our care. We are honored to have this commitment recognized nationally through The Leapfrog Group’s Hospital Safety Grade survey. AdventHealth Hendersonville has earned 16 consecutive “A” grades in these biannual surveys.

One of the efforts to enhance safety for patients involved our Emergency Department.

In the fall of 2022, the clinical team at AdventHealth Hendersonville observed a troubling trend. Too many patients that were visiting the Emergency Department were leaving before they could be evaluated by a provider. This observation, termed “Left Without Being Seen (LWBS)” is a known quality and safety concern for Emergency Departments across the country. In response to this observation, AdventHealth Hendersonville organized a task force dedicated to improvement in this area.

The higher rate of LWBS wasn’t entirely surprising. At that time, AdventHealth Hendersonville was doing major remodeling to add eight additional examination rooms in the Emergency Department. For an extended period of time during that construction, the waiting room shifted to a temporary space, which was small and seemed cramped during busy times of the day.

At the end of the construction, AdventHealth restored the Emergency Department waiting room to a comfortable and roomy space. This provided noticeable improvement in patients staying to be treated. However, the ED team was still observing times of the day when patients were experiencing longer waits and opting to leave before being seen. AdventHealth saw there was still room for improvement.

The task force asked patients for feedback to help AdventHealth understand their reasons for leaving and not waiting to be seen. One patient offered some useful insight stating, “The waiting room was very crowded. I didn’t want to wait behind that many people.” The team realized that a crowded waiting room gave the perception of a long wait.

The task force then began to study the patterns of patient visits to the Emergency Department. The Emergency Department nursing and physician leadership adjusted their staffing to match the highest volume times.

“With input from our clinical team, we structured our shifts to add coverage for the busiest times of day and evening, and added nursing shifts to support peak times,” shares Josh Darling, MSN, RN, Director of the Emergency Department at AdventHealth Hendersonville. “Our charge nurses were given the autonomy to flex staffing to match our census, which helped us manage the flow of patients.”

AdventHealth continued to work on improving flow and reducing crowding. They used clinical team members and space to move patients through Emergency Department visits efficiently and as quickly as possible, while still taking care to deliver a compassionate, high-quality experience. These efforts helped the team achieve a 2.8% reduction in LWBS. As of May 2024, the LWBS rate was 0.7%, well within the goal of less than 1% LWBS for the Emergency Department.

Emergency Department Flow Updates Help Patients Get Safe, Efficient Care (1)

The work of the task force and the ED team has significantly improved the waiting experience for all patients who visit the emergency department at AdventHealth Hendersonville. When waiting cannot be avoided, the team clearly communicates expectations to patients and families, and continues to extend uncommon compassion to every person coming to AdventHealth Hendersonville for care.

Like many other Emergency Departments, AdventHealth sees some patients coming to the Emergency Department for minor illnesses – coughs and colds – which could be more efficiently cared for with their primary care provider or by visiting AdventHealth Centra Care. Patients who visit the Emergency Department at AdventHealth Hendersonville with non-emergent illnesses will use a fast-track system that helps move them through their visit in the Emergency Department quickly. This, in turn, also helps reduce the LWBS rates.

At AdventHealth Hendersonville, our Care Management team connects with patients and navigates them to primary care providers if they don’t have one. The hope is to prevent the need for a future Emergency Department visit. When cost is a barrier, particularly for patients who do not have health insurance, AdventHealth Care Managers are connecting patients with community agencies that offer free or low-cost care.

“It is critically important that we are part of the solution that helps patients seek and establish primary care at a price they can afford,” shares Gretchen Nicholson, MBA, MT, CPHRM, CPHQ, Director of the Office of Collaborative Improvement and Medical Staff Services at AdventHealth Hendersonville. “Affordable primary care is available in this community. We want to be part of navigating patients to the right care setting for what ails them.”

Emergency Department Flow Updates Help Patients Get Safe, Efficient Care (2024)


How to improve patient flow in emergency departments? ›

Three Strategies for Improving Emergency Department Flow, Crowding
  1. Reevaluate front-end processes to provide patients timely care. ...
  2. Related: Effective Transitions of Care After Discharge Process. ...
  3. Provide care in appropriate care spaces. ...
  4. Eliminate unnecessary boarding by evaluating inpatient processes.
Jan 26, 2020

How to manage flow in the emergency department? ›

  1. manage risk in a defensible fashion and avoid solving non-emergency problems.
  2. communicate with patients.
  3. communicate other ED and non-ED staff.
  4. deal with admitting teams in a professional manner.
  5. constantly monitor departmental flow.
  6. manage your time.

What are the areas of improvement in the emergency department? ›

Rapid triage system, fast-track lanes, efficient staff allocation, enhanced communication about wait times, and comfortable waiting areas. Advanced resuscitation techniques, quick access to critical care resources, regular training, coordination with intensive care units, and continuous learning culture.

How to improve patient satisfaction in emergency department? ›

How to Improve Patient Experience in the Emergency Department
  1. Start with research. ...
  2. Optimize patient flow. ...
  3. Emergency visits are unexpected, explore providing basic items to patients while they wait. ...
  4. Include customer service as part of the emergency department's standards. ...
  5. Create a clean, safe environment.

How might improved flow help improve the quality of care for patients? ›

Optimising patient flow in hospitals ensures that patients receive the best available care while saving time, effort and costs. Failing to achieve hospital-wide patient flow puts patients at risk for suboptimal care and potential harm, as well as increasing hospital staff burden.

How to run an efficient emergency department? ›

Efficiency in the Emergency Department
  1. Strategies for Doing Things Faster.
  2. Among his recommendations:
  3. Stay focused. ...
  4. Don't waste free time. ...
  5. Anticipate phone calls to staff and residents for consults. ...
  6. Admit patients who obviously need to be admitted. ...
  7. Be flexible. ...
  8. Remember that we're emergency physicians—not internists.

What are the ED performance measures? ›

Direct and indirect measures of quality of care, including left without being seen, did not wait, as well as patient and provider satisfaction, were commonly reported ED process performance measures. Cost-based measures indicate the financial implications of health care provided.

What is the patient flow process? ›

Patient flow is the movement of patients through a healthcare facility. It involves the medical care, physical resources, and internal systems needed to get patients from the point of admission to the point of discharge while maintaining quality and patient/provider satisfaction.

What is emergency flow? ›

The ED flow coordinator is an individual (typically an experienced nurse) whose objective is to facilitate and improve movement of patients into and out of the ED, serving as a liaison between the ED and inpatient units or ancillary departments.

What makes a good emergency department? ›

While waiting to see the doctor, there should be comfortable areas available for you and your family. During care itself, a great Emergency Department should have private treatment areas and quick access to advanced diagnostic technology needed to best assess every emergency.

What are the smart goals for the emergency department? ›

These goals should be specific, measurable, achievable, relevant, and time-bound (SMART). Examples include reducing patient wait times by a certain percentage or improving patient satisfaction scores. Use the Goals feature in ClickUp to create SMART goals and assign them to relevant team members.

What are the ways of maintaining patient and staff safety in the emergency department? ›

Safer Working Conditions for Emergency Department Staff
  • Appropriate separation of patient care and staff work areas.
  • Appropriate visibility between and within treatment areas.
  • Secure areas for at risk or violent patients.
  • Working and functioning equipment, clinical tools, and furniture.

What are the 5 P's of patient satisfaction? ›

The focused hourly assessment includes the completion of the evaluation of the“5P's”: Pain, Potty, Positioning, Possessions and Personal needs.

How to increase patient satisfaction in urgent care? ›

Smile - It may seem obvious, but a happy and efficient staff can significantly improve patient satisfaction. A simple smile and personal greeting can go a long way with patients. Front desk staff is the first and last impression of your office, so it is wise to invest in happy people.

How do you increase patient flow? ›

Ways to improve your layout may include:
  1. Displaying easy-to-read signs to lead patients and staff through the facility.
  2. Creating a sequence flow so patients aren't crossing or retracing where they've been to get to their next area.
  3. Providing stand-up workstations for staff to access records and take notes easily.

How can nurses improve patient hospital experience to improve patient flow in hospitals? ›

10 Tips for Improved Patient Experience

Assess operational and patient flow to maximize efficiencies to prevent delays or waiting time for the patient. Deliver effective, caring and compassionate communication with the patient and/or family, focusing on empathy. Say hello. Acknowledge the patient by name.

How do you maintain patient flow? ›

Strategies for improving patient flow
  1. Better organisation of clinical staff shifts (rostering)
  2. Reduced delays in associated services (e.g. blood testing)
  3. Introduce new or better software solutions.
  4. Recruit more staff.
  5. Better oversight of capacity and demand to improve planning.
Aug 29, 2023

How can we improve patient intake process? ›

You can improve a slow patient intake process by optimizing how you collect data from patients. Asking patients to show up early for appointments to fill out forms often doesn't yield consistent results. Instead, ask patients to complete and turn in forms well before their appointments.

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