UCLA Santa Monica Nethercutt Emergency Department

Santa Monica, California

A multidisciplinary team led by UCLA Santa Monica Nethercutt ED staff nurses redesigned waiting room workflows to address overcrowding by creating dedicated care spaces, defining nursing roles – including pivot, blood draw and medication nurses – and collaborating with physicians on streamlined assessments and medication protocols. The initiative improved efficiency, enhanced patient privacy and accelerated care delivery. After implementation in July 2025, the left without being seen rate decreased from 1.2 percent to 0.6 percent, and arrival-to-physician time improved from 15 to 9 minutes. Despite treating 5,500 more waiting room patients, the length of stay remained stable for the 21-bed department, while staff satisfaction and confidence in patient care significantly increased.

The department also identified delays in thrombolytic treatment for stroke patients during overnight telemedicine coverage. ED and stroke teams analyzed workflow data and demonstrated that treatment decision-making was the primary cause of prolonged door-to-needle times which helped successfully advocate for 24-hour in-person neurology coverage. Following implementation in January 2025, median door-to-needle time improved from 62 minutes in the first quarter of 2024 to 29.5 minutes in the fourth quarter of 2025. The team consistently achieved the 60-minute thrombolytic benchmark and exceeded it by meeting the more aggressive 45-minute door-to-needle goal to significantly improve the timeliness of stroke care.