A walkthrough of a Green Belt project that reduced door-to-provider time by 32%.
Door-to-provider time is one of the most consequential metrics in emergency medicine. It correlates with patient satisfaction, left-without-being-seen rates, and clinical outcomes for time-sensitive conditions. This case study walks through a Green Belt project that took a community ED from a 47-minute median to 32 minutes in six months.
Define
The project charter scoped the work to ESI level 3 patients arriving between 10:00 and 22:00, the highest-volume cohort. The primary metric was median door-to-provider time; balancing measures included left-without-being-seen rate and provider satisfaction.
Measure
Baseline data showed wide variation by hour of day and by triage nurse. The team built a value stream map and discovered that 40% of the elapsed time was queue time before triage even began.
Analyse
- Triage was a single-threaded process during the busiest hours.
- Registration was happening before triage, adding queue time for stable patients.
- The provider-in-triage role existed on paper but was not consistently staffed.
Improve
The team piloted a quick-look triage protocol, moved registration to bedside for ESI 3 patients, and committed to provider-in-triage coverage during peak hours. Pilots ran for two weeks each, with daily huddles to surface issues.
Control
A control plan with run charts, weekly review, and a documented escalation path locked in the gains. Six months after go-live, performance had held — and the ED nursing team had taken ownership of the metric.