Utilizing Coordinated Discharge Planning to Drive Improvement in Patient Throughput in the ED

This project was a  quality improvement (QI) project to decrease fragmentation of care in the emergency department (ED) to reduce the time from physician disposition to discharge in mid-level acuity ED patients.


Emergency Departments are under an increasing pressure to accommodate a growing census while providing quality care and patient satisfaction. Currently, the effort to discharge patients is not coordinated, resulting in a lengthier discharge process and a less than optimal understanding of the discharge plan. This can result in return visits, patients not being satisfied with their care, and employee burnout.  We focused on coordinated discharge planning process which included a interdisciplinary team to reduce the time from discharge disposition to ED departure in our vertical area (a designated patient care area for ambulatory patients with a mid level emergency severity index score). 




Analysis of the data from March 11, 2017 to July 26, 2017 revealed 81% days met the target (median time of 16 minutes or less) for overall time savings of 7 minutes per patients. The baseline mean before the improvement project was  20 minutes. The ED team achieved the goal by decreasing the baseline mean from 20 minutes to 12 minutes during the intervention phase. Since implementation, the ED has sustained this metric at a median time of 15 minutes.




The nurses now feel empowered to continue to drive improvements with patient throughput within the ED. Team collaboration and effective communication has decreased fragmentation in care and reduced the time from discharge disposition to departure by 7 minutes per patient

Sustainability Plan:

-contributed by Karen Stuart, MSN, CEN, Jamie Stone, MBA, RN, Kelly Anderson, BA, Courtney Azevedo, Tess Golfo, BSN, RN, Alejandra Martinez, Alexei Wagner, MBA, MD, Teresa Yip, MSN, RN, CEN, CPEN, Patrice Callagy, RN, MPA, MSN, CEN

@Stanford Nursing 2018