Promising Practices for

Improving Emergency Department Operations

The emergency room waiting area.


Managing crowding is a problem for all hospitals across the United States that operate emergency departments, and it brings the potential for serious negative consequences for health care access, quality and patient safety. Crowding and poor patient flow cause patients to remain in the ED longer than necessary. Delays in care also cause some patients to leave the ED before being seen by a provider.

Quick Facts

  • According to the U.S. Centers for Disease Control, from 1996–2006, annual ED visits grew from 90.3 million to 119.2 million nationally.
  • As more become uninsured or unemployed and access to primary care becomes more difficult, the use of the ED for non-urgent care and preventable conditions is on the rise.
  • The most common and documented cause of ED crowding is the inability to move admitted patients from the ED to an inpatient bed.

More from Aligning Forces for Quality (AF4Q)

Aligning Forces for Quality (AF4Q)
Aligning Forces for Quality

Latest: Emergency Department Operations

Post-Visit Patient Contact Improves Patient Satisfaction

April 8, 2013

Contacting patients the day after an ED visit has helped Edward Hospital & Health Services consistently achieve 95 – 99 percent Press Ganey satisfaction scores, reduce the risk of negative outcomes following discharge, and collect patient data.

Posting Data on Bulletin Board Improves ED Flow

February 27, 2013

Good Samaritan Hospital staff measured wait times and patient flow using real time data which was compiled and displayed on an electronic bulletin board. Good Samaritan reduced ED throughput time for admitted patients by 102 minutes.

Improve ED Flow With “Quick Hits” Meetings

February 27, 2013

Avera Marshall Regional Medical Center implemented a series of meetings known as ”quick hits” to solicit ideas and input into how to solve some of its most pressing ED problems. Avera reduced its ED decision-to-admit time by 12 minutes per patient.

Clinical Leaders in ED Improve Throughput

February 26, 2013

Truman Medical Center Lakewood implemented a Clinical Team Leader position in the emergency department, improving left without being seen rates from 7.7 percent to 6.8 percent.

Stony Brook ED Consult Tracking Form

February 4, 2011

Stony Brook University Medical Center developed and implemented a standardized process with tracking and accountability for emergency department (ED) consult requests.

Charted Door-to-Bed Process Flow Chart

February 4, 2011

St. Francis Hospital in Indianapolis improved door to bed, length of stay and patient satisfaction by reducing delays in ED triage and registration.

Faxed Report Form for Emergency Department, Inpatient and Nurse Supervisors

February 4, 2011

Excela Health Westmoreland Hospital improved patient throughput rates by improving communication between the emergency department (ED) and the receiving inpatient units.

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