Waiting room zero until noon: An emergency department quality improvement initiative with downstream effects

Abstract

Background: Rising ED boarding and visit volumes are challenges to maintaining patient flow and avoiding patients leaving without being seen. Objectives: We aimed to decrease left without being seen and improve ED patient flow by minimizing time patients spent in the waiting room in the early hours of the day when treatment spaces are usually available. Methods: We implemented a “Waiting room zero before noon” campaign in our urban community emergency department. Providers and nurses were messaged about this goal and the expectation was set that patients should be brought to a room even if a nurse was not immediately available to care for them. Results: In the three months following this campaign, we experienced a significant decrease in left without being seen. This decrease persisted over the subsequent two years, despite increasing patient volume. Conclusion: A simple, cost-neutral campaign aimed at changing workflow culture was able to achieve improvements in patient flow despite continued challenges of rising boarding and volume.

Keywords

• Left without being seen
• Waiting times
• Direct bedding
• Emergency department
• Patient flow