Dramatic Improvements in ER Flow, Patient Satisfaction, Employee Engagement through an Internal Project: Phases 1 and 2

 Here is a summary project plan for a house-wide ER/ Patient flow project from ChatGPT. It is research based and from my 40 years experience as a hospital consultant, with 30 of those in the ER, it includes all the best practices save a small handful. It's a great checklist for any hospital to conduct their own first-pass assessment, and begin planning for an internally-driven improvement project.

Hospitals that combine split-flow triage, real-time dashboards, and a safety-first communication culture often see the fastest improvement in both error reduction and throughput.

Phase 1: Rapid Wins (0–3 months)
Focus on visible, quick changes to build momentum.
1. Provider-in-Triage Pilot
In a busy ER, Place a physician, an NP and a veteran Triage RN in triage to initiate labs, imaging, and treatment.
Metric: Reduce Left Without Being Seen (LWBS) by ≥30% in 3 months.

2. Fast Track for Low-Acuity Patients
Create a separate care stream for ESI 4–5 patients (sprains, minor lacerations, URIs). Most ERs have this but don't have well-engineered protocols to reliably ID in Triage who will need more.
Metric: Decrease median length of stay (LOS) for ESI 4–5 patients by 25%.

3. Checklists for High-Risk Presentations
Stroke, chest pain, and sepsis bundles at triage.
Metric: Door-to-needle (tPA) and door-to-antibiotic times reduced by 20%.

Phase 2: System Redesign (3–9 months)
Address bottlenecks and system errors with structured process improvement.

1. Real-Time Flow Dashboard
Electronic tracking board showing: patient location, labs pending, imaging complete, boarding times. I've seen excellent custom built dashboards using internal IT / PI collaborations.
Metric: Daily huddles reviewing wait times, aiming for <30 min median door-to-provider time.


2. Lean Process Improvement
Map patient flow → identify bottlenecks (e.g., labs, imaging).
Apply 5S to supply/med rooms.
Metric: Decrease door-to-disposition decision time by 15%.

3. Structured Handoffs
Adopt SBAR for all handovers.
Metric: Monitor error reports; target ≥20% reduction in adverse events linked to communication.

See Next Post for Phase 3


✅ Takeaway: Start small (provider-in-triage, fast track), then scale into system redesign (dashboards, lean workflow), and finally embed a culture of safety and predictive management.

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