Dissertation
Improving Emergency Department Efficiency and Effectiveness to Accommodate Increasing Patient Census
University of Iowa
Doctor of Nursing Practice (DNP), University of Iowa
Spring 2026
Abstract
Background: The emergency department (ED) has evolved beyond treating life-threatening conditions to also managing nonurgent care, contributing to overcrowding and reduced care quality. Fast-track (FT) models were implemented to improve efficiency by streamlining care for low-acuity patients. Purpose: This quality improvement project evaluated and optimized the fast-track process in a Midwestern community hospital ED to improve patient throughput, satisfaction, and staff workflow. Methods: This project was reviewed by the Institutional Review Board and was deemed non–human subject research. Using the Plan-Do-Study-Act framework, two evidence-based electronic order sets were developed and implemented alongside staff education to improve adherence to a vertical care/fast-track workflow. Data were collected over 12 weeks (4 weeks pre-implementation and 8 weeks post-implementation) through chart reviews, EHR reports, compliance audits, and anonymous staff surveys. Outcomes included patient length of stay (LOS), net promoter score (NPS), and staff satisfaction. Descriptive statistics and independent t-tests were used for analysis, and qualitative responses were analyzed thematically. Findings: Average LOS decreased during the intervention period, reflecting improved throughput. NPS increased from 6 to 42, indicating improved patient satisfaction despite interim variability. Staff reported improved workflow efficiency and role clarity. Discussion: Workflow-focused interventions improved ED efficiency and satisfaction with minimal resources. However, modest LOS reductions suggested that ED crowding was influenced by broader system-level constraints. Sustainable improvements required both process optimization and health system–level change. Keywords: Emergency Department; fast-track; overcrowding; length of stay
Details
- Title: Subtitle
- Improving Emergency Department Efficiency and Effectiveness to Accommodate Increasing Patient Census
- Creators
- Tara M Jacks - University of Iowa
- Contributors
- Olivia Croskey (Chair) - University of Iowa
- Resource Type
- Dissertation
- Project Type
- Poster
- Degree Awarded
- Doctor of Nursing Practice (DNP), University of Iowa
- Degree in
- Family Nurse Practitioner
- Date degree season
- Spring 2026
- Publisher
- University of Iowa
- Number of pages
- 1 page
- Copyright
- Copyright © 2026 Tara M Jacks
- Language
- English
- Academic Unit
- College of Nursing; Doctor of Nursing Practice Projects
- Record Identifier
- 9985217065502771
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