Blog Article:
Reimagining Emergency Department Flow: How One ED Transformed the Patient and EMS Experience
June 2, 2025
Emergency departments (EDs) are no strangers to long wait times, overcrowded hallways, and stressed EMS crews. But what if we could eliminate the bottlenecks, reduce delays, and dramatically improve both patient and EMS satisfaction? That’s exactly what Progressive Emergency Physicians (PEP) and Good Samaritan University Hospital on Long Island, NY, did by redesigning its emergency care model—and the results are nothing short of remarkable.
The Problem: Long Waits and Inefficient Triage
Traditionally, EMS crews experienced delays at high volume times, often lining up awaiting triage. The teams were asked to navigate the busy ED to approach the charge nurse and have their patient entered into the system, assigned a clinical team, and a bed. The EMS crew would then transport the patient to the ED bed for transfer. The charge nurse was often busy with other operational issues. Door-to-provider times hovered around 40 minutes, and EMS turnaround times lagged. These delays also impacted walk-in flow and volume, and LWBS rates approached 4%.
The Solution: A Team-Based Approach Right at the Door
The ED team at Good Samaritan University Hospital tackled these inefficiencies head-on with a comprehensive redesign of their intake and triage process, starting right at the ambulance bay. They created an EMS Nurse Team—a nurse and a technician stationed inside the ambulance entrance, with clean stretchers lined up and ready.
When EMS arrives:
- Patients are immediately transferred to a hospital
- The nurse performs a quick look assessment and enters the patient into the system.
- The tech completes a full set of vital signs.
- Within minutes, the patient is moved to their assigned room and assigned a clinical team.
This streamlined process cuts down EMS and patient waiting times by 15–20 minutes and allows EMS crews to get back on the road faster.
A Game-Changer for Stroke Patients
The system also includes a Direct-to-CT protocol for stroke patients. Physicians now evaluate potential stroke cases right in the EMS hallway. The stroke team is activated either by EMS via pre-notification or by the EMS nurse or EM physician on arrival, expediting advanced imaging and treatment, which is critical in time-sensitive cases.
Redesigning Triage: Quick Look Nurses and Direct Bedding
Another transformative change was the elimination of the traditional waiting room/triage model. Instead, patients are now greeted by a Quick Look Nurse the moment they walk through the door. This clinician-greeter performs a rapid initial assessment (about 7–8 key questions) and directs the patient accordingly:
- If triage nurses are busy, the Quick Look Nurse initiates the process.
- There is now 99% direct bedding, meaning patients go straight to a treatment bed instead of being delayed in the waiting room.
- Door-to-provider time dropped from 40 minutes to just 12–13 minutes.
To support this fluid process, the registration team now rounds to patient beds, further removing delays from the intake experience with bedside registration.
Physician in Entry (PIE): Early Clinical Decision-Making
The introduction of the Physician in Entry program has elevated the model further:
- Physicians work alongside Quick Look and triage nurses to assess walk-in patients on arrival.
- Based on initial evaluation, patients are either directed to Supertrack with less severe complaints or directed to the phlebotomy/EKG station for rapid initiation of orders placed by the PIE.
- Laboratory testing provides results within 45 minutes.
This system virtually eliminated LWBS cases and also reduced treat-and-release time.
The Impact: By the Numbers
The introduction of the Physician in Entry program has elevated the model further:
- 91,000+ annual ER visits
- LWBS dropped from 3–4% to ~1%
- Door-to-provider time: down to 12–13 minutes
- Reduction in treat and release times
- Patient satisfaction continues to rise year over year
A Blueprint for the Future of Emergency Care
PEP’s process redesign at Good Samaritan University Hospital shows what’s possible when clinical innovation, teamwork, and patient-centered thinking intersect. From placing physicians at the door to empowering nurses and techs for immediate action, this model delivers faster, safer, and more satisfying care—for both patients and EMS crews.
Want to learn more? Contact our Business Development Team today.