Troubleshoot Triage to Improve Patient Flow

Emergency Waiting Room Donovan Partners

Seven years ago — from December 2008 through February 2009 — approximately 13 percent of patients who visited the emergency department at Hahnemann University Hospital in Philadelphia left without ever being seen. Over a three-month time period, the 31-bed ED had more than 8,800 visits — overcrowding was a significant problem.

The very next year, over the same three-month time frame, Hahnemann’s ED saw almost 800 more patients — close to nine more per day — but the LWBS rate dropped significantly. Even with the increased patient volume, the ED’s LWBS rate decreased by more than three percent. Three months later, the LWBS rate had dropped even lower to six percent.

But how?

In June 2008, Hahnemann’s ED leadership made a commitment to improve patient flow, and soon partnered with the Urgent Matters Learning Network II — a 6-hospital collaborative that worked with one another to improve patient flow and alleviate overcrowding. Through the consortium, they were able to develop a triage process that worked for their specific hospital given its size, staffing structure and urban location. (ED leaders at Hahnemann ultimately decided to implement the ESI 5-level triage system; introduce a policy of bringing patients to an open bed for triage and registration; and dedicate resources, staff and space for patient fast tracking. And it worked.)

For Hahnemann, implementing an improved patient flow process at triage resulted in lower LWBS rates, less overcrowding and increased morale among its staff. Higher patient satisfaction scores soon followed.

A more recent example of what can result when an ED prioritizes patient flow is Florida Hospital Tampa (FHT), an ED that had been experiencing a nearly 40-percent annual spike in patient volume as it suffered from a 21-percent staff turnover rate. And if that wasn’t enough, patients were ranking its doctors in the bottom ninth percentile nationwide.

An analysis by the Healthcare Financial Management Association outlines how FHT was able to develop and implement a flexible patient flow process combining two proven strategies: team triage and immediate bedding. Dubbed Doc1stER, the new patient flow triage strategy produced quick results — after two months FTH was the most improved ED in its 41-hospital system.

No two EDs are the same and strategies to improve patient flow aren’t one-size-fits-all — staffing, location and space are just a few factors that have to be considered. ED leaders wanting to improve patient flow triage need a plan tailored specific to their ED. With a proven record of being able to identify and develop patient flow strategies, Donovan and Partners can help you examine and improve your current triage process, and then help you implement a plan to improve patient flow in your ED. Contact us today at or 651-260-9918. To learn more about the complete set of health care consulting we offer, please visit


Healthcare Financial Management Association: “7 Tips for Improving Emergency Department Patient Flow.”

Hospitals in Pursuit of Excellence: “Improving ED Flow through the UMLN II.”