Practice Improvement| Volume 44, ISSUE 6, P582-588, November 2018

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Stop the Bottleneck: Improving Patient Throughput in the Emergency Department



      Emergency department nurses are faced with an overwhelming number of patients each day. The average number of emergency department visits is increasing by 3.5% per year. Numerous studies have been conducted to improve the patient throughput process, which has impact on patient flow. A disruption of the process can cause a backlog of patients and create a hardship for both patients and staff.


      The Plan-Do-Study-Act (PDSA) cycle was used as a specific improvement methodology for improving patient throughput and served as a component for the Model for Improvement approach. The article presents a quality improvement initiative created and implemented to improve patient flow by adding a flow nurse coordinator. The flow nurse coordinator was proposed to improve patient throughput by expediting and facilitating transport of the admitted patient to an inpatient bed.


      The average time from notification of bed assignment to patient arrival to an inpatient bed was 104 minutes, almost twice the proposed benchmark and more than the regional average. The results of the quality initiative changed patient arrival to inpatient bed from 104 minutes to 84 minutes, a decrease of 20%.


      The quality initiative team made several recommendations based on the research of a flow nurse coordinator. The recommendations included a weekly ED staffing committee meeting, consisting of frontline ED staff, nurse educators, ED leadership, and flow nurse coordinator. The support and active involvement of the executive leadership team would assist in sustaining changes to the new process.
      Contribution to Emergency Nursing Practice
      • The current state of scientific knowledge on emergency department overcrowding indicates a need to improve patient throughput.
      • The main finding of this research is to improve patient throughput, improve patient and staff satisfaction, and improve patient outcomes.
      • Key implications for emergency nursing practice from this research are to decrease the risk for medical errors, missed and delayed treatments.
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      Ray DeAnda is Nurse Manager at Texas Health Resources, Fort Worth, TX.