Emergency Department: Optimizing Capacity with the Usage of Rapid Medical Evaluation

Emergency department overcrowding has created patient throughput challenges with 2012 volume already exceeding budget. Left without being seen rates have been above the 2 percent Premier national benchmark. Time-to-provider minutes also were higher than desired, contributing to the LWBS rate of 3.6 percent and the discharged length of stay median time of 227 minutes.

Lean principles were applied to ED throughput processes by driving out waste and redesigning the system to create a smoother, more valuable process for all customers.

The front end ED visit process was redesigned with the implementation of rapid medical evaluation. An internal waiting room was established for non-acute patients that allowed more beds to be available in the main ED.

A multidisciplinary team was formed and in under six months, time-to-provider decreased from 86 minutes to 28 minutes—a 67 percent improvement. The median length of stay for discharged patients decreased from 227 minutes to 147 minutes—a 35 percent improvement. LWBS decreased from 3.6 percent to 0.54 percent—an 85 percent improvement.

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This case study is part of the Illinois Hospital Association's annual quality awards. Each year, IHA recognizes and celebrates the achievements of Illinois hospitals in continually improving and transforming health care in the state. These hospitals are improving health by striving to achieve the Triple Aim--improving the patient experience of care (including quality and satisfaction); improving the health of populations; and reducing the per capita cost of health care.

Award recipients achieve measurable and meaningful progress in providing care that is:

• Safe
• Timely
• Effective
• Efficient
• Equitable
• Patient-centered

(The Institute of Medicine's six aims for improvement.)