Texas Health Harris Methodist Hospital Fort Worth is part of a 25-hospital system and one of the busiest emergency departments in the country. With 635 inpatient beds, the hospital houses a 100-bed ED, which treated approximately 120,000 patients last year. Its admission rate is high at 24 percent, and it has a high ambulance arrival rate of 30 percent. The ED leadership and staff moved into their new facility approximately two years ago, and it boasts five zones and 75,000 square feet. Even before moving to the new facility (the old one was only a third of the size), the department had a reputation for service quality and efficiency.

The Texas Health Fort Worth ED has unrivaled performance in both clinical and operational metrics. Most of its core measure metrics (pneumonia, stroke, ST elevation myocardial infarction, sepsis) had performance above 95 percent, with many at 100 percent. Further, its operational performance is unheard of in EDs seeing more than 100,000 patients a year:

• Door-to-doctor time is 20 minutes.
• Overall length of stay is 185 minutes.
• Length of stay of admitted patients is 291 minutes.

What are some of its strategies for such outstanding workflow, patient flow, and clinical quality? This department is staffed by an extremely stable physician group with strong leadership and a long history of service quality. The ED group was founded and led by John Geesbreght, MD, FACEP, who was formerly in the military and is, by all accounts, a visionary and a gifted operational thinker. He was joined early on by Elliott Trotter, MD, and Ralph Baine, MD (who was a nurse when he initially joined the group), who shared his vision for an efficient and patient-centric emergency medicine practice. Interestingly, Texas Health Fort Worth has some half a dozen physicians who came up through the ranks as nurses or scribes and then returned to the group after completing medical training.

Physicians … move from the highest-acuity area to the lowest-acuity area during a shift.

Dr. Geesbreght and his leadership team have designed one of the most unique and original physician-staffing models in use. Despite promoting individual physician efficiency, this physician group recognizes that there are fast physicians and slow physicians. Though the group tracks efficiency metrics on all physicians and inspires them to work as efficiently as possible, it realizes that there are intrinsic differences. Doctors are monitored for productivity and classified as green, yellow, or red, indicating the highest to lowest productivity, respectively. This is not used in a punitive fashion because this group recognizes that each physician member contributes to the good of the group in some way: some are researchers, some are teachers, some are IT experts, and some play a role in the EMS community, etc. However, when the clinical schedule is crafted, there is careful effort not to schedule consecutive or concurrent red physicians.