The culture at Scripps Mercy San Diego is unique and hard to find. The department was extraordinarily quiet as I walked through, and yet there was an urgency to see the next patient, to make the next disposition. There was little tolerance for waits and delays, and the entire department was rowing in the same direction to keep the waiting room empty. This ED is a lesson on how a shared culture can overcome many ED obstacles.
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ACEP Now: July 2025No matter the operating model, an ED will likely struggle with achieving results without a strong team culture that puts patients first. I can’t argue with the success story that is told by this department’s metrics. And it all comes down to culture!
Dr. Welch practiced emergency medicine for 35 years. She was an emegencry department (ED) quality director for Intermountain Healthcare. She has written articles and books on ED quality, safety, and efficiency. She is a consultant with Quality Matters Consulting, and her expertise is in ED operations, patient flow, and work flow.
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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.