Rush University Medical Center Emergency Department

Chicago, Illinois

Rush University Medical Center located in Chicago is a comprehensive emergency department with annual visits of ~70,000 and 5th time designated Magnet hospital.

Continuous Pursuit of Excellence (CPE) is Rush’s focus on constantly working to improve by providing value, delivering the highest-quality patient care and timely services, by engaging those closest to the work to become problem solvers. Using this methodology from their previous CPE work, this ED gathered a multidisciplinary team of providers, nurses and PCTs, as well as key members of ancillary services teams to address opportunities identified on proper identification of low resource appropriate patients and efficient ordering of labs and imaging from triage with alignment of patient arrivals and staffing. They created a “staff to demand” heatmap and realigned both nursing and provider shift times. This, in combination with placing initial orders for these patients, resulted in both increased capacity and increased efficiency in their low resource pod.

In addition to these gains, this workflow redesign also resulted in a significant decrease in Left Without Being Seen (LWBS) volume. Prior to the implementation, monthly LWBS had been as high as 4.4%. Following the implementation of this process, they have achieved — and maintained — an annual LWBS rate of < 1.5%. This process has also allowed for improved patient safety by increasing the situational awareness of ED providers regarding the patients in the waiting room. Ordering labs and images from triage allows earlier identification of significant abnormalities and expedited rooming of these patients.