Category Archives: Summer 2016

Reinventing emergency department flow via physician-directed queuing system results in decreased wait time

In this CHOT study, a new flow model of emergency care delivery, physician-directed queuing (PDQ), was created after analysis of operational data and staff input of an overcrowded academic health center emergency department (ED) with increasing patient volumes and limited physical space for expansion. After implementing the PDQ model, the researchers observed a 91% decrease in door-to-bed time (211 to 19 minutes), an 83% decrease average waiting time (70 to 12 minutes), and increased patient satisfaction (from 17% to 85%).  In order to design this PDQ, researchers analyzed the operational data and staff input of an overcrowded academic health center emergency department (ED) with increasing patient volumes and limited physical space for expansion. EDs are a critical point of entry into the healthcare system. ED overcrowding create barriers to access and provision of appropriate care. ED crowding is associated with less timely care, decreases in patient satisfaction, and poor outcomes. With the new PDQ model, providers passively evaluate all patients upon arrival, actively manage patients requiring fewer resources, and direct patients requiring complex resources to further evaluation in ED areas. This model of practice can be applied to other patient care settings such as ambulatory care and imaging.

DeFlitch, C., Geeting, G., & Paz, H. L. (2015). Reinventing emergency department flow via healthcare delivery science. HERD : Health Environments Research & Design Journal, 8(3), 105-115.


Research Contact:
Harriet Nembhard, PhD

Significant cost saving attained with the implementation of a new ED decision support system

Improving an emergency department’s (ED) timeliness of care, quality of care, and operational efficiency while reducing avoidable readmissions, is fraught with difficulties, which arise from complexity and uncertainty. A recent CHOT study describes an ED decision support system that allows healthcare administrators to optimize workflow globally, taking into account the uncertainties of incoming patient diseases and associated care, thereby significantly reducing the length of stay (by 33% in the study hospital) and waiting time of patients (by 70%). This system couples machine learning, stimulation, and optimization to address these complex challenges. Using this system offers significant advantages in that it permits a comprehensive analysis of the entire patient flow from registration to discharge, enables a decision maker to understand the complexities and interdependencies of individual steps in the process sequence, and ultimately allows the users to perform system optimization. Overall benefits and impacts include improved timeliness of care, improved efficiency and emergency care, annual financial savings and revenues, encouragement of external sponsorship; health cost reductions, and improved quality of care in other facilities. It has been used successfully since 2010.

The quality of care impacts include 30% reduction of length of stay, and 70% of the associated average waiting time; 28% reduction in ED readmissions; 32% re-direct of non-urgent-care cases; 19% increase in ED throughput; and 30% reduction of patients who left-without-being-seen. The “golden hours of treatment” for trauma patients was reduced by 10%. The ED efficiencies at Grady led to a 10% reduction in ED-to-hospital admissions. 

The financial impacts of the ED efficiencies at Grady include a $7.5 million yearly savings in penalties due to a reduction in revisits. The alternative care facility for non-urgent conditions reduces ED costs by $21.6 million and results in $12.5 million in revenue. Expansion of trauma care and efficiency results in $19.1 million in revenue; the reduction in left-without-being-seen patients leads to $96.6 million in revenue. For a critical safety-net hospital with $1.5 billion of annual economic impact, only 8% of which results from private insurance, these financial gains have a tremendous impact on maintaining financial healthiness.

Lee, E. K., Atallah, H. Y., Wright, M. D., Post, E. T., Thomas IV, C., Wu, D. T., & Haley Jr, L. L. (2015). Transforming Hospital Emergency Department Workflow and Patient Care. Interfaces.


Research Contact:
Eva Lee, PhD