Reducing Emergency Department ICU Critical Care Boarder Hours

Boarding patients in the emergency department (ED) is detrimental to patient care, and evidence suggests that critical care patients boarded in the ED have longer lengths of stay and higher mortality rates. From April 2013 to September 2014, the hospital had an average of more than 934 nursing hours per month dedicated to caring for critical care boarder patients in the ED. These excessive hours impacted patient care and patient safety and created operational and clinical issues.

Using a Lean Six Sigma methodology, the hospital reduced the number of ED nurse staffing hours dedicated to caring for intensive care unit boarder patients by more than 50 percent in a six month period, from 934 hours per month to 467 hours per month. The estimated nursing staff cost savings is $312,000 per year.

This case study is part of the Illinois Health and Hospital Association's annual Quality Excellence Achievement Awards. Each year, IHA recognizes and celebrates the achievements of Illinois hospitals and health systems in continually improving and transforming health care in the state. These organizations 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—and the Institute of Medicine's six aims for improvement—safe, effective, patient centered, timely, efficient, and equitable. To learn more, visit https://www.ihaqualityawards.org/javascript-ui/IHAQualityAward/