CASE STUDY:
TRANSFORMING EMERGENCY DEPARTMENT FLOW: HOW CORE’S VERTICAL MODEL SLASHED LWBS RATES, INCREASED PATIENT SATISFACTION, AND GENERATED $1 MILLION IN SAVINGS
OVERVIEW
At a 400-bed Midwest community hospital, Core Clinical Partners transformed an underperforming Emergency Department into a high-functioning, patient-centered environment. By introducing a vertical flow model, stabilizing clinical leadership, and driving culture change, Core reduced Left Without Being Seen (LWBS) rates from 6.3% to under 1.2% and recovering an estimated $1 million in annual revenue. Simultaneously, patient satisfaction scores soared to over 90% and door-to-doctor times dropped by 63%, aligning the department with national benchmarks.
THE CHALLENGE
When Core partnered with a Midwest community hospital’s Emergency Department, the facility faced critical challenges affecting both patient care and financial performance:
- High Left Without Being Seen (LWBS) rate (6.3%) — Patients were leaving without receiving care, representing approximately $1 million in lost annual revenue and creating significant patient safety concerns.
- High Left Before Treatment Complete (LBTC) rate (8%) — Patients leaving against medical advice (AMA) and those leaving without notice (Elope), along with LWBS patients, highlight additional patient safety challenges.
- Low patient satisfaction scores (63% Top Box) — Patient experience suffered due to extended wait times and inefficient
- Extended Door-to-Doctor time (27 minutes) — More than double the 50th percentile national benchmark (per EDBA benchmarks) for this size ED.
- Unstable physician staffing — The department had no full-time physicians and relied heavily on PRN and locum physicians unfamiliar with the facility’s workflows, resulting in inconsistent care
- Leadership gaps — The Emergency Department lacked consistent oversight from a Medical Director and operated with an interim contract nursing
These issues created an opportunity-rich environment, making delivering timely, quality care increasingly difficult. The delay from arrival to initial clinician evaluation proved especially problematic, fueling the high LWBS rate and plummeting satisfaction scores.
THE SOLUTION
Core implemented a systematic, phased approach to transform this Emergency Department’s performance:
Comprehensive Operations Assessment
To lay the foundation for improvement, Core conducted an end-to-end operational assessment of the Emergency Department, evaluating workflows from front-end intake to back-end discharge. This collaborative assessment with key stakeholders, including Inpatient Medicine, Laboratory, and Radiology, revealed critical bottlenecks in patient flow, particularly delays in registration and triage that hindered timely clinician evaluation.
Establishing Stable Leadership
Core recruited a full-time board-certified emergency physician as Medical Director to drive cultural change and clinical excellence. This leadership stability became the foundation for implementing and maintaining new processes.
Building a Full-Time Clinical Team
Core supplemented the Emergency Department with locum tenens clinicians to stabilize staffing and support long-term sustainability while simultaneously building a permanent team. Over time, Core recruited and onboarded a dedicated group of board-certified Emergency Medicine physicians and advanced practice providers (APPs), creating greater cohesion, continuity, and alignment in care delivery.
Implementing the Vertical Flow Model
Following its initial operational assessment and leadership stabilization, Core introduced its vertical flow model, a streamlined approach designed to reduce Door-to-Doctor time. The model implements Immediate Bedding to Acuity-Based Zoning, where patients are seen by the APP or physician based on their triage acuity.
Nursing Partnership
With the Core Clinical Operations team’s background as emergency nurses, clinicians, and leaders, Core effectively bridged the gap between physician and nurse collaboration. They worked closely with the new nursing director to implement front-end flow changes.
Strategic Intervention Timeline
Core implemented sustained on-site interventions over three years, including:
- Operations Assessment
- Vertical Flow Model
- EMTALA Education
- Leadership Development
- Core Cares Observation/Coaching
- Nurse-Driven Protocol Orders
- Emergency Severity Index (ESI) Triage Training
This comprehensive, phased approach reflected Core’s ongoing commitment to continuous improvement, with each intervention building on the last to drive sustainable progress in patient care.
THE RESULT
Core’s interventions yielded significant, measurable improvements:
LWBS Rate Reduction
One year after implementing the vertical flow model, Core reduced the LWBS rate from over 6% to under 1.2%, resulting in approximately $1 million in annual revenue recovery. This improvement increased ED throughput and ensured more patients received timely care.
Patient Satisfaction Improvement
Patient satisfaction scores increased by 27 percentage points following Core’s interventions. Scores rose from the baseline of 63% to consistently above 90%, placing the hospital in the top 10% nationally for Emergency Department patient satisfaction.
Door-to-Doctor Time Transformation
The most dramatic operational improvement came in door-to-doctor time, which fell from an average of 27 minutes to just 10 minutes—a 63% reduction aligned the emergency department with best-practice benchmarks.
Most importantly, Core implemented control measures rooted in Lean and Six Sigma methodologies to ensure the sustainability of these outcomes over time.
THE TAKEAWAY
- LWBS decreased from 6.3% to 1.2%, an improvement of 5.1 percentage points.
- LPTC dropped from 8% to 2.7%, an improvement of 5 percentage points.
- Press-Ganey patient satisfaction scores rose from 63% to 90%, an increase of 27 percentage points.
- Door-to-doctor time improved from 27 minutes to 10 minutes, a reduction of 17 minutes.
- The estimated annual revenue impact increased by $1 million.
This success story exemplifies Core’s mission of improving patient care through genuine partnership. While many groups offer physician staffing as a transactional service, Core provides a fully integrated Emergency Department management approach that includes thorough operational assessment, meaningful relationships, collaborative solutions, and shared knowledge from successful implementation.
Take the first step toward better results. Contact us and see what a true partnership can do for your hospital.