The emergency department at Virginia Commonwealth University (VCU) in Richmond is one of the busiest teaching hospital emergency departments in the country. Seeing 95,000 visits a year, the adult and pediatric emergency departments were engaged in flow projects that improved their operational metrics. However, they wanted to take the adult emergency department to the next level.
The ED leadership—Harinder Dhindsa, MD, MPH; Jeremy Sauer, MD; Kathy Baker, RN, PhD; Christi Adams, RN, MSN; Anne Jackson, RN; and Jonathan Heller—had already implemented a “physician in triage” model, which reduced door-to-provider times. However, bottlenecks often meant patients went back to the waiting room, and they often eloped. In addition, the fast track, which was staffed by advanced practice providers, was underperforming, often seeing only 12 patients a day. The mid track was also not optimized. Using data-driven flow strategies, the leadership team crafted a flow model specific to its needs. It dubbed the new model “Vision in Action.”