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The Problem Facing Emergency Departments: Improving ED Throughput

The Emergency Department has become the Grand Central Station of the American Healthcare System. ­­­­­­­Multitudes of people are coming and going in an extremely hectic environment every single day.

Emergency Department visits have reached epidemic proportions. Here are some staggering statics around ED visits in the US. 


As a result of this surge in the ED patient population, hospitals have a serious patient flow crisis. There are some recurring themes in hospital administration meetings. Do any of these themes sound familiar to you?

  • ED Crowding
  • ED Delays
  • ED Diversions

It’s no secret that longer emergency room waiting times can lead to worse patient outcomes and lower patient satisfaction scores. In this critical department of the hospital, each moment can make a huge difference in the life of the patient.

This broken model isn’t sustainable and needs immediate attention. Many of our clients acknowledge this crisis but, in most cases, adding additional capacity or staffing is not possible. One way to handle this epidemic is ensuring efficient patient flow processes and managing ED throughput. 

Although it varies widely by geographic location, the national average patient wait time in the emergency room before seeing a doctor is 24 minutes. Improving ED throughput can be accomplished by instituting several changes in the hospital ED setting.


Using a technology solution, like Medisolv’s RAPID software, to monitor and analyze ED throughput is critical for improvement. Regardless of what solution you use, you should have an ED throughput report that monitors these six key time points.

  1. Arrival
  2. Triage
  3. Patient in Room
  4. Seen by Doctor
  5. Decision to Admit as Inpatient or Depart from ED
  6. Departure

By monitoring these time points, you can assess the time interval between each step. Clearly documenting these time points is the first step to improving ED throughput.


Of course, merely monitoring your performance across those time points is not enough. Your hospital executives will want to see these time points in a comprehensive report that shows your performance over a rolling 12-month period, for any given month and on any given day.

If you don’t have a good handle on your numbers, this is your first place to start. Just begin by charting it out and seeing if you have a problem. Then analyze your numbers thoroughly. Is it a certain day of the week or weekend where you have problems? Is it a certain shift? By identifying trends you will have the information you need to at least start experimenting to fix the problem.


If your hospital does not currently have a designated patient flow team, now is the time to institute one. This multidisciplinary team is used to plan quality improvement interventions. The AHRQ recommends that this team include a team leader (e.g., day-to-day leader), senior hospital leader (e.g., chief quality officer), ED physicians and nurses, ED support staff (e.g., clerks, registrars), representatives from inpatient units and a research/data analyst. Forming this team will allow representatives from each affected unit to have their voice heard and will also send a clear message to all staff that the hospital is making ED throughput a high priority in your hospital.


If your EHR has an auto advance function, we strongly encourage you to use this as often as possible. This function ensures that your patient is moved to the next EDM status as soon as a certain action takes place. For example, when the Receive function is filed – auto advance status moves the event to Received.  When the Triage Assessment is filed – auto advance status moves the event to Triaged. This will help your hospital ensure your time stamps are accurate.


Leadership at every level of the health care delivery system is essential to sustain the cultural and operational changes needed to improve ED throughput in your hospital. Make sure that your executive team understands why this is critical. With executive buy in, your hospital will be more willing to invest the financial and staffing requirements needed to make improvements.

Medisolv offers a software solution to monitor and improve your ED throughput times. Our clinical consultants work with your hospital to set up an effective suite of ED reports customized for your hospital. They also provide expert consultations to help your hospital improve. Talk to us today about our RAPID software solution to improve your ED throughput results.

By the way, if you are a current Medisolv Rapid client you already have this functionality available to you today! If you have questions about the ED report, please email

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Adrienne Greason

Adrienne is a Senior Consultant on the abstracted measures team for Medisolv.

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