Internal and Emergency Medicine

, Volume 13, Issue 6, pp 923–931 | Cite as

Emergency department throughput: an intervention

  • Nowreen Haq
  • Rona Stewart-Corral
  • Eric Hamrock
  • Jamie Perin
  • Waseem KhaliqEmail author


Shortening emergency department (ED) boarding time and managing hospital bed capacity by expediting the inpatient discharge process have been challenging for hospitals nationwide. The objective of this study is was to explore the effect of an innovative prospective intervention on hospital workflow, specifically on early inpatient discharges and the ED boarding time. The intervention consisted of a structured nursing “admission discharge transfer” (ADT) protocol receiving new admissions from the ED and helping out floor nursing with early discharges. ADT intervention was implemented in a 38-bed hospitalist run inpatient unit at an academic hospital. The study population consisted of 4486 patients (including inpatient and observation admissions) who were hospitalized to the medicine unit from March 2013–March 2014. Of these hospitalizations, 2259 patients received the ADT intervention. Patients’ demographics, discharge and ED boarding data were collected for from March 4, 2013 to March 31, 2014 for both intervention and control groups (28 weeks each). Chi-square and unpaired t tests were utilized to compare population characteristics. Poisson regression analysis was conducted to estimate the association between intervention and hospital length of stay adjusted for differences in patient demographics. Mean age of the study population was 58.6 years, 23% were African Americans and 55% were women. A significant reduction in ED boarding time (p < 0.001) and improvement in early (before 2 PM) hospital discharges (p = 0.01) were noticed among patients in the intervention groups. There was a slight but significant reduction in hospital length of stay for observation patients in the intervention group; however, no such difference was noted for inpatient admissions. Our study showed that dedicating nursing resources towards ED-boarded patients and early inpatient discharges can significantly improve hospital workflow and reduce hospital length of stay.


Hospital workflow Early hospital discharges ED boarding time Hospital length of stay 



This work would not be possible without the efforts of the ADT nursing team (Christine Barton, RN, CMSRN, MSN, Leilani Turman, RN, CMSRN, Jonathan Espenancia, RN, CMSRN, Shahida Khan, RN, CMSRN, Sol Marte, RN, BSN).



Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study formal consent is not required.


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Copyright information

© SIMI 2018

Authors and Affiliations

  • Nowreen Haq
    • 1
  • Rona Stewart-Corral
    • 2
  • Eric Hamrock
    • 3
  • Jamie Perin
    • 4
  • Waseem Khaliq
    • 1
    Email author
  1. 1.Division of Hospital Medicine, Department of Medicine, Johns Hopkins Bayview Medical CenterJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Johns Hopkins Bayview Medical CenterJohns Hopkins University, School of NursingBaltimoreUSA
  3. 3.Department of Operations IntegrationJohns Hopkins Health SystemBaltimoreUSA
  4. 4.Johns Hopkins Bloomberg School of Public Health, Department of International HealthBaltimoreUSA

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