Independent Community Hospital Improves Emergency Department Flow and Revenue

BRG professionals collaborated with an independent not-for-profit healthcare system in the northeastern United States consisting of one community hospital with outpatient centers and provider practices. The hospital is licensed for seventy-two beds and discharges 3,875 inpatients annually. Its emergency department (ED) consists of thirty-two spaces treating over 35,000 patients each year.

Prior to the engagement, the ED’s median length of stay (LOS) was 272 minutes (released LOS – 243 minutes; admitted LOS – 422 minutes), resulting in a total left before treatment completed (LBTC) rate of 5 percent and a left without being seen (LWBS) rate of 3 percent.

The system requested that BRG work with its leadership team and organization to decrease LBTC and LWBS, improve door-to-provider times, and decrease overall LOS. BRG’s Emergency Services Solutions (ESS) team partnered with organizational and provider leadership to modify processes, utilizing two primary processes to effect results:

1. Decrease ED arrival to provider time
2. Optimize disposition to admit times for patients admitted to the hospital

BRG collaborated with ED leadership and staff to modify the “intake” process. This included adding a registered nurse at the point of arrival who, together with registration personnel, quickly registered and triaged patients walking into the department. After triage, the RN communicated a bed need with assigned staff who escorted patients to the treatment area. If no treatment space was immediately available, the triage RN initiated physician-approved protocols based on the patient’s condition.