Reducing Adult Emergency Department Length of Stay

The Challenge:

Transforming Patient Care, was borne of the desire to free up Nurse and Patient Care Associate time.  The goal was to use freed up time to meaningfully engage patients at the bedside.

National healthcare publications have demonstrated significant gains in clinical outcomes, quality of care and patient safety and satisfaction through increased interaction between patients and their direct caregivers.

The target set was to provide YNHH’s direct patient caregiver staff (RN’s and PCA’s) one hour per shift per caregiver. This hour was to be used to provide support for patients’ medical, educational and emotional needs.

Along with seeking improvements in caregiver processes and behaviors there was a requirement to evaluate and eliminate constraints among the upstream and downstream support departments including:

  • Plant & Clinical Engineering
  • Food & Nutrition
  • Pharmacy

The Results:


Management System changes were installed including:

  • Development and installation of a detailed plan for work completion at key intervals during each caregiver’s shift that is measured for completion accuracy.
  • Bedside Hand off – Confirmation that patient hand offs at shift changes are conducted at the bedside and engage the patient.
  • A process change was installed where nurses began real-time documentation of the medication being administered at the patient bedside.


  • Installed Service Level Attainment – A measure of the completion of requested work orders within specified turnaround times.
  • Plant Engineering SLA improved 33% and Clinical Engineering SLA improved 10% resulting from process and management system changes that were installed.


  • Improved pharmaceutical availability and scheduled pharmacy deliveries to better accommodate administration periods and eliminate duplicate medicinal delivery locations.

Food and Nutrition:

  • Key process changes balance workload across high volume meal-time periods, take advantage of available resource capacity and improve service quality across all hours of operation.
  • All performance metrics are reviewed daily by process owners to identify variances and develop action plans.  An overhaul of behaviors and systems now allows a Senior Operations Group to review performance periodically to drive accountability and challenge sustainability.

The Client Experience:

“The integrative approach you employ to help implement change and then coach our managers has proven very effective and will ensure that the changes are sustained.”

Senior Vice President, Yale-New Haven Hospital

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