In addition, the Scripps Mercy San Diego ED is unique in terms of its physician group: Pacific Emergency Providers (PEP), APC, is a single-department, independent, democratic physician group with 15 physician partners, eight APPs, and a cadre of other full-time and part-time practitioners. APPs function in a supportive role to physicians and every patient is seen by a physician!
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ACEP Now: July 2025PEP has had this contract for 20 years and is closely aligned with their hospital leadership. The hospital leadership does its part to support the emergency physician group by keeping the boarding burden to a minimum (103 minutes versus 189 minutes EDBA benchmark) and by providing efficient ancillary services, particularly imaging. Turnaround times for all imaging modalities are faster than recorded benchmarks.
Does this atypically staffed and run department work? As you can see in Table 2, PEP is an unusually high-performing ED.
How Do They Do It?
How does this department do so well without using all of the best practice tactics of other departments of the same volume? It all comes down to culture.
Both physicians and nurses are recruited to find stakeholders who share the same work ethic and commitment to efficiency, quality, and courtesy in caring for patients. On my tour, I was impressed at how often I heard the phrase “this is better for the patient.” Conversely, I did not hear “that is not my job” or “that is not my patient.” These “all-hands-on-deck” and “patients- first” imperatives embedded into the culture at Scripps Mercy San Diego are palpable.
The Scripps Mercy San Diego ED is continuously trialing improvements and this changeoriented culture has bred amazing innovation. In particular, they have responded to the BH crisis in their community by adopting BH order sets for patients awaiting psychiatric evaluation and placement. The ED has cordoned off four rooms to create a BH pod that moves these patients to a quieter area. The physicians have become comfortable discharging a high percentage of patients with BH issues and are comfortable with a number of BH therapeutic interventions for the sickest patients. They have gotten proficient at treating substance abuse and are credentialed to prescribe buprenorphine and naloxone (Suboxone) for patients who will follow-up in appropriate settings.
Because the ED has overperformed for many years, it has been rewarded with many amenities including a case manager 12 hours a day, 24-hour critical care/intensivist coverage, and 20-hours-a-day clinical pharmacist coverage.
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2 Responses to “Scripps Mercy Hospital San Diego’s Unique ED Culture Breeds Innovation”
August 3, 2025
Michael Lipscomb, MD, FACEPDear ACEP Now Editorial Team,
Thank you for publishing this great article on the Scripps Mercy Hospital San Diego emergency department. The so-called “secret sauce” of operational best practices is well known to anyone who’s spent time in an ED. What’s much less common and so critical—is true hospital-wide buy-in and the full commitment of ED staff to these principles.
The most impactful elements highlighted were:
1. The hospital’s system-wide commitment to reducing boarding times by prioritizing timely inpatient discharges.
2. Robust ED pharmacist coverage—20 hours a day, per the article.
3. 24/7 critical care support for the ED.
4. Consistent case management presence—12 hours a day.
5. And most importantly, a deeply embedded culture of “patients first,” not “me first.”
I hope hospital administrators and other EDs across the country read this and take note. The more these approaches are adopted, the more we’ll see them become standard practice—and the better care our patients will receive.
Best regards,
Mike
August 3, 2025
Ev FullerKudos for getting hospital leadership to understand the ED’s needs. Looking at this article, 200-ish daily volume with 50+ rooms and 12 hallway beds, as long as the ED is fully staffed and with only a 100 minute delay to get admitted patients upstairs sounds like how EDs are supposed to work. For context, I currently work in an ED with 35 beds and daily volumes of 100-120 so should meet the 4 patients/bed/day standard for ED throughput…BUT…typically holding 15-25 boarders with boarding times often hitting 96 hours. While their flow model is certainly different from an equivalent size ED, I think the CULTURE difference there is that inpatient boarding is recognized as the primary driver of ED congestion and the ED and hospital leadership has prioritized getting admitted patients upstairs to let the ED do ED things.