Reducing Door-to-Triage Patient Times in the Emergency Room

The Problem:
The door-to-doctor time is a valuable quality metric that has become increasingly important as the volume of patients streaming into Emergency Departments increases each year. Getting the patient to triage quickly is a big driver of both patient satisfaction and ensuring quality across the continuum of care.

The Goal:
To take a systemic approach to improving the inpatient flow performance in order to reduce the door-to-triage time.

Method & Implementation:
At William Jennings Bryan Dorn VAMC in Columbia, the Office of Process Improvement utilized Lean Six Sigma principles to develop a daily management analytics tool—dubbed the Emergency Department Management Tool—to assist the ED staff in improving and sustaining their door-to-triage time. By aggregating and condensing data in an easily comprehensible presentation that provides automated, standardized reporting each day, staff were able to easily adapt and improve their inpatient flow performance with demonstrable results.

Results:
Since implementing the new tool and analytics, the Emergency Department at William Jennings Bryan Dorn VAMC has reduced their ED wait times by 42%, going from an average of 19 minutes to 11 minutes, which exceeds the national standard for door-to-triage times. The ED also saw decreases across total length of stay (20.9%), door-to-provider median minutes (65.2%) and percent of patients who leave without being seen (62%). These numbers have been sustained over the 12 months after the tool was implemented.

The Emergency Department Management Tool has since been identified as a best practice within the larger VA Southeast Network and has been rolled out to each of the eight hospitals within it as well as the Palo Alto, California VAMC.

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