14 Optimizing emergency department to inpatient flow: balancing efficiency and safety

<h3>Description</h3> Efficient emergency department (ED) to inpatient flow improves care access by decreasing ED waiting room times and optimizing the patient/caregiver experience. The goal was to decrease the average time from ED admit disposition set to ED departure for patients at our main campus by 25% by June 31, 2024. Our multi-disciplinary team created a process map which revealed an overly complex system with stakeholders identifying delays due to room cleaning, accessing the correct equipment, and provider handoff. We then created a key driver diagram which guided intervention design (figure 1). Serial PDSA cycles were used to test/refine interventions on one inpatient unit prior to widespread implementation. Our key interventions focused on automation, streamlining workflow, and coordinating patient transport while unit preparation and provider handoff are ongoing (table 1). The average time for our main outcome measure decreased by 25% to 110 minutes (figure 2). We saw no change in safety balancing measures, such as emergency transfers to the intensive care unit within 12 hours of admission. Engaged leadership across multiple sites of care was integral to our project success.