Long Island Jewish Valley Stream Emergency Department, Northwell Health

Valley Stream, New York

Long Island Jewish Valley Stream Emergency Department implemented a split-flow model and Super-Track area to reduce overcrowding, delays and patients leaving without being examined. Nurse-led quick-look triage and immediate physician evaluation rapidly identify patient acuity, so patients are directed to appropriate care settings and ED beds are preserved for critical patients. Care orders are initiated from the front end to expedite care, while licensed practical nurses enhance efficiency and throughput. Despite a recent 22 percent increase in patient volume, these interventions reduced door-to-triage times by 45 percent, door-to-physician times by 55 percent and the length of stay by 36.5 percent. Patients leaving without being examined dropped from 2.79 percent to 1 percent.

The 41-bed department’s shared governance model empowers clinical nurses to identify care gaps, design solutions and drive evidence-based improvements. Another key exemplar is the IV push antibiotic initiative for early sepsis treatment. Through the ED Collaborative Care Council, clinical nurses initiated a collaboration with physicians, pharmacy and clinical education to replace traditional IV piggyback workflows with IV push administration. A pilot demonstrated significant results: median order-to-administration time dropped from 41 to 27 minutes, time to efficacy improved from 30 to five minutes, and total treatment time decreased by nearly 40 minutes—with zero medication errors or adverse events.