Reducing Throughput From Emergency Department To Acute Care

Project Topic:

Reducing Throughput from ED to Acute Care

Hospital, City and State:

Methodist Fremont Health, Fremont, Nebraska

Units:

• Emergency Department
• Acute Care

CSI Participants:

• Kaylyn Biery, BSN, RN
• Ann Feltner, BSN, RN, ONC
• Roni Foote, BSN, RN
• Brittany Sager, BSN, RN

Project Goals/Objectives:

1. By the end of September 2026, patients admitted to the acute care unit from the ED, achieve an average throughput time of less than 60 minutes from the ED Physician’s admission order to the patient’s arrival on the acute care unit.
2. By the end of February 2026, the ED and Acute Care units will have a 10% increase in the Health Work Environment Assessment Tool (HWEAT) scores in relation to the standards of Skilled Communication and True Collaboration.
3. By the end of February 2026, the ED and Acute Care units will each have a 10% decrease in the Oldenburg Burnout Inventory (OLBI).

Project Outcomes:

1. Reduced the average throughput time from 103.92 minutes to 86.19 minutes which is a 17.06% decrease
2. Emergency Department Skilled Communication fell from 4.23 to 3.58
3. Emergency Department True Collaboration fell from 4.23 to 3.50
4. Acute Care Department Skilled Communication increased from 3.63 to 3.99
5. Acute Care Department True Collaboration increased from 3.50 to 4.06
6. Emergency Department OLBI decreased from 38.92 to 38.75
7. Acute Care Department OLBI decreased from 40.47 to 38.83

Project Overview:

The CSI Throughput Project, Accelerating Admission Throughput with ADMITS, is a communication-driven initiative designed to improve the efficiency, safety and coordination of patient admissions from the Emergency Department (ED) to the Acute Care unit. Guided by the slogan, “From ED door to patient’s bed, we work as one…enough said,” this project focused on standardizing handoff communication to ensure that all critical patient information is shared clearly, consistently, and without delay. At the center of this work is the ADMITS framework, which organizes handoff communication into Assessment, Diagnostics, Medications, Inpatient Plan, Tasks outstanding and Safety. For behavioral health patients, the SAFE framework—Situation, Assessment, Focused Psych and Extras—provided a parallel structure tailored to their specific needs. Together, these tools created a shared language that reduced variability, strengthened collaboration, and supported timely, safe patient movement.

The goal of the project was to improve communication and collaboration between the ED and Acute Care teams while achieving an admit order to unit arrival time of less than 60 minutes. Key strategies included implementing standardized handoff processes using ADMITS and SAFE, ensuring timely updates of bed availability every four hours through a daily communication chat, and fostering interdisciplinary collaboration among Acute Care Attending RNs, hospitalists, ED staff and bed coordinators. By aligning these teams around a common framework and shared accountability, the project aimed to reduce delays and improve overall throughput.

To support adoption and engagement, the rollout incorporated creative and visible strategies that reinforced the initiative’s messaging and build team enthusiasm. These included a themed launch with star costumes, an elevator speech and the A.D.M.I.T.S. handoff song set to the tune of “Twinkle, Twinkle, Little Star,” which helped staff remember the framework in a simple and engaging way. Additional efforts included energy drink carts with ADMITS-themed swag, visual reminders such as posters and phone stickers, and incentive programs with gift card drawings and unit-based competitions to encourage consistent use of the tools.

Implementation began with leadership engagement through presentations at the Nurse Executive Council in August and the House Supervisor and Attending meeting in September, followed by staff education and introduction of the ADMITS and SAFE tools throughout September and October. Full adoption in October, with continued reinforcement through incentives in November and December, visual reminders and competitions in January, and sharing of progress and outcomes in February. Ongoing evaluation included monitoring admit order to arrival times through the ED dashboard, assessing use of the handoff tools, and measuring team communication and collaboration through the HWEAT-Teams tool and staff well-being through the Oldenburg Burnout Inventory at completion of the CSI program. Through this structured yet engaging approach, the project aimed to reduce admission delays, improve communication, enhance patient safety, and strengthen the overall experience for both patients and care teams.

The project did not reach the target of reducing the average throughput time of 60 minutes from admit order to arrival on the Acute Care unit although there was a significant decrease of 17.06% (103.92 to 86.19 minutes). The Emergency Department had a decrease in the HWEAT scores related to both Skilled Communication (4.23 to 3.58) and True Collaboration (4.23 to 3.50). While the Acute Care Department had an increase in both Skilled Communication (3.63 to 3.99) and True Collaboration (3.50 to 4.06). Both departments decreased the risk of burnout as evidenced by the OLBI scores, Emergency Department went from 38.92 to 38.75, and the Acute Care Department went from 40.47 to 38.83.