The Christ Hospital Health Network

Cincinnati, Ohio

To reduce the number of patients leaving the before completing care, a multidisciplinary initiative redesigned patient flow using a direct bedding model in The Christ Hospital ED. Rapid triage is followed by immediate placement in an available treatment space, where triage documentation and the medical screening exam occur without returning to the waiting room. Supporting strategies include real-time capacity monitoring, staggered staffing, standardized communication, structured rounding and escalation pathways. Daily metric review and shared governance sustain accountability. Following implementation, the overall rate of patients leaving prior to completion of care decreased from more than 4 percent to less than 2 percent, where it has remained for more than 12 months despite increasing volume and boarding pressures.

Through shared governance, multidisciplinary collaboration and evidence-based guidelines the 44-bed ED made additional improvements. Automated EKG orders were embedded in the electronic health records for high-risk cardiac complaints to eliminate provider-dependent delays and standardizing early evaluation. Door-to-EKG time improved from 12 minutes pre-implementation to nine minutes in 2025. A multidisciplinary sepsis committee similarly translated Surviving Sepsis Campaign recommendations into triage screening, electronic alerts and a standardized Sepsis Alert pathway. Time to antibiotics decreased from more than 200 minutes to less than 90 minutes within 45 days. It now averages less than 40 minutes.