Does sharing process differences reduce patient length of stay in the emergency department?

Study objective: We assess the ability of the best demonstrated processes ( BDP) methodology to decrease emergency department patient length of stay (L OS) in EDs in a large multihospital system. Methods: Two hundred ninety-one EDs were ranked by LOS, and the fastest and slowest EDs were observed to identify the BDPs. The resulting "meaningful differences" were shared with all EDs throughout the hospital system. LOS s tudies were repeated after the BDP intervention. Five separate LOS measures were performed during a 19-month period, with 223 to 273 EDs participating in each measure. Three interval times were calculated: arrival to examinat ion room, examination room to physician evaluation, and physician evaluatio n to discharge. Results: Two hundred ninety-one EDs participated, and 386,837 patient visit s were evaluated. Before intervention, the average LOS was 147 minutes for all EDs and 186 minutes in the slowest third. At 19 months after interventi on, the average LOS was 139 minutes for all EDs and 157 minutes In the slow est third. Between the initial and final measurement period, there was an 8 -minute (5.4%) improvement in LOS on a system-wide basis, and the slowest t hird of EDs improved LOS by 29 minutes (15.6%). Before intervention, arriva l to examination room time was 27 minutes, examination room to physician ev aluation was 20 minutes, and evaluation to discharge was 100 minutes. After intervention, these times decreased to 22 (P < .001), IS (P < .001), and 9 9 (P=.33) minutes, respectively. The slowest one third of EDs went from 37 to 24 minutes for arrival to examination room time (P < .001), from 25 to 2 0 minutes for examination room to evaluation time (P < .001), and from 124 to 113 minutes for evaluation, to discharge time (P < .001). Conclusion: Implementing observed BDP meaningful differences resulted in de creased patient LOS in EDs, particularly in the slowest one third of EDs in the hospital system.