CASE STUDY
Transforming Emergency Care
Lake Emergency Partners at Insight Chicago
Executive Summary
When Lake Emergency Partners (LEP) assumed management of the emergency department at Insight Chicago, the department faced a range of operational, staffing, and quality challenges. Through disciplined execution and a commitment to continuous improvement, LEP transformed the ED into a high-performing, patient-centered department, achieving measurable gains across key metrics within two years.
Key Outcomes At A Glance
<2%
LWOT Rate
down from 6.8-7.4%
13-15 min
Door-to-Doc Time
down from 30+ minutes
< 2%
Chart Delinquency Rate
down from 300-500 charts
38%+
Level 5 Charting
up from 26%
10-14%
Patient Volume Growth
year-over-year increase
96-98%
Patient Satisfaction
consistently maintained
The Challenge
At the outset of the agreement, Insight Chicago’s emergency department faced several interconnected operational challenges:
- Left Without Being Seen (LWOT) rates averaged 6.8–7.4%, with occasional spikes above that range, indicating significant access and throughput bottlenecks.
- Door-to-physician times frequently exceeded 30 minutes, limiting the department’s ability to triage and treat patients efficiently.
- 300 to 500 charts were incomplete or delinquent at any given time, creating compliance risk and billing inefficiencies.
- Multiple physician departures prior to the agreement left the department short by approximately three providers, straining remaining staff.
The Approach
LEP implemented a structured, data-driven improvement strategy focused on four pillars:
- Operational Throughput: Redesigning patient flow processes to reduce wait times and eliminate bottlenecks at triage and intake.
- Provider Recruitment & Stabilization: Aggressively recruiting qualified emergency physicians to restore full staffing and build a durable team.
- Documentation Excellence: Delivering targeted, one-on-one education to providers to improve charting accuracy, compliance, and coding quality.
- Strategic Advancement: Pursuing key certifications (including EDAP, trauma, and SANE center status) to expand capabilities and community access.
Progress was monitored quarterly, with consistent improvement each reporting period.
Results
Phase 1: Q4 2024, Early Wins
Within the first phase of the partnership, significant gains were realized across all priority areas:
- LWOT reduced to 2%, from a baseline of 6.8–7.4%
- Door-to-physician time improved to 21 minutes
- Chart delinquencies fell to the 50s, from 300–500 outstanding
- Full staffing achieved; all open physician positions filled
- Level 5 charting improved from 26% to 38%, with many months exceeding 40%
Phase 2: Mid-2025, Sustained Excellence
Building on early momentum, the team continued to drive performance to new levels:
- LWOT held consistently below 2%
- Door-to-physician times averaged 13–15 minutes, a more than 50% reduction from baseline
- Chart delinquency rate fell below 2%
- Multiple full-time physicians recruited; billing stabilized
- Patient volume increased 10–14% year-over-year
- Inpatient admission rate grew from 10% to nearly 13%, reflecting improved acuity recognition
- Transfer rate decreased from approximately 2% to 1%, reflecting stronger in-house capabilities
- Active pursuit of EDAP and trauma certification; documentation submitted for full SANE treatment center certification
What's Behind The Numbers
The metrics tell a compelling story, but the operational changes driving them are equally important. Eduardo Navarrete, MD, Executive Vice President of Lake Emergency Partners, offers insight into the structural and cultural changes that made this transformation possible.
The LEP contract at Insight is metrics-based; accountability is built into the structure of the partnership from day one. Door-to-provider time now sits at under 15 minutes, a performance level that stands in sharp contrast to many large city hospitals, where patients may wait an hour or more before seeing a provider.
The effect on patient behavior is tangible. Patients increasingly choose Insight Chicago’s ED for emergencies, even when their primary physicians practice elsewhere, because they know they won’t face a long wait. That accessibility translates directly into volume growth and community trust.
“Wait time is going to be the most significant indicator of patient satisfaction. Patients don’t go to those bigger hospitals for emergencies — even if their other doctors are there — because of the wait times.”
New Care Model: APPs and the Throughput Committee
Two structural innovations were introduced under LEP that did not previously exist at Insight Chicago’s ED. First, Advanced Practice Providers (APPs) now see patients at the front of the care process and immediately initiate a full diagnostic workup (labs, CT scans, and ultrasounds), eliminating the idle period that once existed between a patient’s arrival and the start of meaningful clinical activity.
Second, LEP established a Throughput Committee dedicated to scrutinizing every facet of the patient journey, from the moment a patient steps into the ED to the moment they leave. This committee meets regularly to identify bottlenecks and drive continuous improvement across the entire care pathway.
A True Physician–Nursing Partnership
One of the most meaningful cultural shifts has been in the relationship between the physician group and nursing staff. In many emergency departments, physicians assume control of patient throughput in ways that can create friction with nursing teams. LEP took a deliberate different approach at Insight Chicago.
Working collaboratively with hospital leadership, the ED team had direct input into hiring a new Nurse Manager, someone selected because they shared the same vision for patient-centered, team-driven care. The result is a nursing team that is a genuine partner in throughput, not a downstream recipient of physician decisions. Nurses are now empowered and actively involved at every stage:
- Performing vital signs and patient assessments proactively upon arrival
- The charge nurse receives incoming EMS calls directly, obtaining vitals and chief complaint before the patient arrives
- The charge nurse leads triage decisions, determining patient acuity and directing flow
- Bedside nurses determine the appropriate room and setting for each patient based on clinical need
This collaborative model has been a critical driver of both throughput efficiency and staff satisfaction, reflecting the kind of culture LEP has worked to build alongside Insight’s leadership.
Before & After Comparison
| Metric | At Contract Start | Mid-2025 |
|---|---|---|
| LWOT Rate | 6.8–7.4% | < 2% |
| Door-to-Doc Time | > 30 minutes | 13–15 minutes |
| Chart Delinquencies | 300–500 outstanding | < 2% delinquency rate |
| Level 5 Charting | 26% | 38%+ (often > 40%) |
| Physician Staffing | ~3 providers short | Fully staffed |
| Patient Volume | Baseline | +10–14% growth |
| Transfer Rate | ~2% | ~1% |
| Patient Satisfaction | N/A | 96–98% |
Patient Satisfaction
Patient satisfaction scores have consistently ranged from 96–98% throughout the partnership, reflecting the high quality of care delivered by the LEP physician team and the patient-centered culture cultivated under Insight’s leadership. These results are a direct outcome of a team that is not only clinically excellent but truly committed to the patient experience.
“I am deeply proud of the progress we have made together. These results reflect both the resilience of our team and the strength of Insight’s leadership in building a culture of accountability, growth, and patient-centered excellence. I feel so lucky to be a part of this amazing Insight Family.”
Conclusion
The partnership between Lake Emergency Partners and Insight Chicago demonstrates what is possible when operational expertise, physician leadership, and institutional commitment align around a shared vision. In under two years, a department facing significant headwinds has become a model of emergency care excellence, with improved access, stronger clinical performance, and a thriving physician team.
LEP remains committed to sustaining and building on these results as Insight Chicago continues to grow its role in the community.