Date of Completion
Summer 2026
Document Type
DNP Scholarly Project
Academic Department
School of Nursing
Degree Type
Doctoral
Degree Name
Doctor of Nursing Practice
Abstract
Problem: Emergency department (ED) boarding increases overcrowding and delays care. A 200-bed acute care hospital in the southeastern United States has a median time from inpatient bed readiness to ED departure that exceeds its hospital benchmarks, resulting in prolonged boarding and delays. Hospital data showed a median bed-ready-to-departure time of 76 minutes, exceeding the target of less than 45 minutes. Workflow analysis identified delays in transport activation, communication, and accountability as major contributors to inefficiency.
Aim of the Project: ED throughput quality improvement project aimed to reduce the median time from when an inpatient bed is marked ready to patient departure from the ED to less than 45 minutes by implementing a structured Pull-based throughput intervention over eight weeks.
Review of the Evidence: The evidence supports that ED boarding causes overcrowding and delays in patient care. The Institute for Healthcare Improvement (IHI) advocates Pull-based patient flow strategies, proactive bed management, and communication processes to improve throughput and reduce delays. Evidence supports that training, interdisciplinary collaboration, and workflow redesign improve patient movement and reduce delays.
Project Design: The project was guided by the Institute for Healthcare Improvement Model for Improvement and implemented using iterative Plan-Do-Study-Act (PDSA) cycles. The OhioHealth Change Management Model supported organizational readiness, stakeholder engagement, education, implementation, and sustainability planning. Baseline workflow mapping and readiness assessments informed the design and implementation of interventions.
Intervention: A standardized Pull-based workflow was implemented by activating transport once the bed was marked ready in the electronic health record. Key components included a bed-ready trigger, five-minute patient-readiness verification, automatic transport activation, defined transport-response expectations, staff education, visual job aids, leadership engagement, and ongoing performance monitoring.
Significant Findings/Outcomes: Median ED departure time improved from 46.6 minutes at baseline to 29.8 minutes by week nine, exceeding the organizational goal. Transport response time improved from 26 minutes to 13 minutes during implementation. No adverse effects on patient safety, staff workload, or front-end ED performance were identified.
Implications for Nursing: Findings suggest structured Pull-based workflow improves throughput, reduces ED boarding, and enhances interdisciplinary coordination. Sustaining improvements requires leadership support, continued education, continued monitoring, and integration of standardized processes into routine operations. The project supports efforts to improve patient flow, operational efficiency, and quality of care.
Recommended Citation
Dundu, Eunice, "Reducing Emergency Department Boarding Using Pull-Based Throughput Intervention: Quality Improvement Project" (2026). Doctor of Nursing Practice (DNP) Scholarly Project. 55.
https://fuse.franklin.edu/dnp-project/55
Rights
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