The leadership team ran four tests of change (rapid cycle testing, or RCT) before going live with the model. Each test of change allowed the team to see the model at work under different conditions. The model was tested with volumes from 284 patients per day (PPD) to 340 PPD, with admission rates of 25 percent to 36 percent and fast-track volumes that varied by 50 percent. The model performed well, and the data were irrefutable.

Table 1 summarizes the remarkable results. The table shows the baseline, the RCT data, and the data-to-date numbers showing consistent improvement for two months. Door-to-doctor median, which began at 52 minutes, was reduced to 22 minutes, and LWBS rates, which were 4.6 percent, were reduced to 1.87 percent.

Their crowning event occurred on April 25, 2016, when the AEC recorded its busiest day ever: The department treated a whopping 364 patients and the door-to-doctor wait time was only 20 minutes.

Most high-volume tertiary and teaching hospitals believe that this type of performance is impossible, but the experience in Rhode Island suggests otherwise. The AEC has been quickly transformed in only 12 weeks from planning through implementation into one of the most operationally efficient teaching hospital EDs in the country. They are rocking in Rhode Island! The Brown University patient-flow model may become the standard for high-volume tertiary teaching emergency departments.