In today’s increasingly strained health care environment, America’s hospital emergency departments (EDs) provide a critical primary and emergency care safety net for every community. Yet over the last decade, studies have deemed the country’s EDs to be at a breaking point, weighed down by crowding as patient volumes have steadily increased and capacity to handle them has decreased.

Recognizing this growing crisis, in 2002 the Robert Wood Johnson Foundation (RWJF) started the Urgent Matters initiative aimed at developing and spreading innovations designed to eliminate or reduce ED crowding. Housed at the Center for Health Care Quality at George Washington University Medical Center (GWU), the initiative has launched two pioneering learning networks with 16 participating hospitals working together to identify, test and implement strategies for improving patient flow and reduce ED crowding.

In the recently concluded second Urgent Matters Learning Network II (LN II), RWJF and GWU partnered with the Agency for Healthcare Research and Quality (AHRQ), and the Health Research & Educational Trust (HRET) of the American Hospital Association to develop and field-test the first ever standardized performance measures for EDs. Unlike other clinical areas, such as cardiac care, that have performance measures covering the full continuum of a patient’s journey through the health care system, the field of emergency care has lacked a universally followed set of performance metrics.

Urgent Matters LN II had three significant goals:

  1. Rigorously evaluate the implementation of strategies for improving patient flow and reducing ED crowding within the context of a hospital learning network;
  2. Advance the development of standard performance measurement in the ED; and
  3. Promote the spread of promising practices to a wider audience and variety of hospitals.


This final report details the success of and lessons learned by the Urgent Matters LN II hospitals in meeting these goals, presenting case studies of the six participating hospitals’ use of different strategies to improve flow in their facilities. While a formal, external evaluation of these strategies is being conducted by HRET, the case studies provide first hand observations of the challenges and preliminary successes as reported directly to UM by the hospitals. The case studies are followed by a discussion of the results of the field test of the ED performance measures and concludes by detailing the dissemination of the learnings from Urgent Matters.