Patient Safety, 2012

University of Kentucky HealthCare Improves Emergency Care Using Door-to-Doc Toolkit

July 2012

Two University of Kentucky (UK) HealthCare facilities, Good Samaritan Hospital and Albert B. Chandler Hospital, redesigned their emergency department (ED) triage process after attending AHRQ-funded training on the "Door-to-Doc Patient Safety Toolkit" for safer, more efficient care in EDs.

UK HealthCare faced difficulties common to EDs across the country: patients leaving without being seen by a provider, long wait times to see a provider, and low patient satisfaction scores. The Door-to-Doc toolkit, developed through AHRQ's Partnerships in Implementing Patient Safety Program, triages each patient, allowing faster admission for those who are very ill and require inpatient care and accelerated treatment of less sick patients.

The Door-to-Doc system keeps the vast majority of patients—those who are less sick—moving during busy times, rather than waiting in the lobby or the ED. Shorter wait times also lead to increased patient satisfaction and hospital revenue, because fewer patients leave the hospital without receiving treatment. The model was first pioneered as an ED patient flow innovation in Banner Health System's Mesa, Arizona, facility, which has since closed.

After implementing Door-to-Doc at the Good Samaritan Hospital, the ED wait times decreased from an average of 48 to 24 minutes. The rate of patients leaving the ED without treatment fell from 3.3 to 1.87 percent. The facility's patient satisfaction scores climbed from 71.5 percent in November 2010 to 81 percent in April 2011.

Chandler Hospital experienced similar improvements after adopting the Door-to-Doc model. The wait time in the ED decreased from 63 to 39 minutes. The rate of patients who left without being treated decreased from 3.13 to 1.89 percent. Patient satisfaction scores rose from 78.3 to 88 percent.

Penne Allison, RN, Director of Emergency/Trauma Services at Good Samaritan Hospital, says, "We completely revamped the way things were done. It was no small task, because it meant we had to reeducate staff and change our processes. Focusing on the front-end processes of the ED can provide hospitals with significant gains."

Knowledge Transfer Case Study Identifier: KT-CQuIPS-103
AHRQ Products: Partnerships in Implementing Patient Safety Program, Door-to-Doc Toolkit
Topic(s): Emergency Medicine, Quality
Scope: Kentucky

Door-to-Doc Patient Safety Toolkit. February 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/edtools.htm#DoortoDoc.

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