SHM Converge Scientific Abstract ePoster Gallery-Dedicated Admitting Shift to Improve Emergency Department Throughput and Hospital Flow: A Quality Improvement Initiative

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This quality improvement initiative addressed emergency department (ED) overcrowding caused by boarding and delayed admissions, which can prolong inpatient stays and contribute to physician burnout. Traditionally, hospitalists handled both inpatient rounding and new admissions, creating a “dual responsibility” that fragmented care, interrupted rounds, and slowed throughput.<br /><br />To improve flow, a dedicated admitting shift was launched in January 2025 at a Level I trauma center. The model used one physician from 7 AM to 7 PM and one advanced practice provider from 6 AM to 6 PM, both focused exclusively on ED admissions. The change was implemented by restructuring existing staffing in a budget-neutral way, with only modest institutional incentives.<br /><br />The intervention improved operational efficiency and clinician experience. ED consult-to-bed time decreased from 88 minutes to 65 minutes, a 26% improvement. Admissions completed within 90 minutes rose from 70% to 77%. Hospitalist length of stay decreased from 6.1 to 5.7 days, and hospital-wide length of stay fell from 5.4 to 5.13 days. The project also reported 6,600 bed-days freed and an estimated $6.6 million in savings. Importantly, 96% of hospitalists reported satisfaction, citing better workflow and fewer interruptions.<br /><br />The initiative was FTE-neutral, demonstrating that meaningful throughput gains can be achieved without increasing staffing. The authors conclude that a dedicated admitting model can improve ED throughput, reduce crowding, support physician well-being, and enhance hospital performance. While results were promising, they noted that flow still depends partly on external factors such as transport and bed management. Overall, the model offers a scalable and reproducible framework for hospitalist services.

Asset Subtitle

Nilesh Patel

Meta Tag

Author List JJ Janoyan, Lee Hyun, Nilesh Patel

Category Innovations

Concept Emergency Department Boarding

Concept Dedicated Admitting Shift

Concept Delayed Admission

Concept Hospital Crowding

Concept Hospitalist Model

Distinguished Non-Finalist

Presenter Organization University of Tennessee Medical Center

Presenting Author Nilesh Patel

Track Quality Improvement

Keywords

emergency department overcrowding

boarding

delayed admissions

dedicated admitting shift

hospitalist workflow

patient throughput

length of stay

bed-days freed

physician burnout

budget-neutral staffing

Emergency Department Boarding

Dedicated Admitting Shift

Delayed Admission

Hospital Crowding

Hospitalist Model