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ED Grows Volume and Improve Press Ganey Score

Improve ED Metrics

Lawrence & Memorial Hospital

ED Volume: 86,000

The Challenge

Lawrence & Memorial HospitalThe Lawrence Memorial Hospital initially partnered with USACS in 2007 to operate their main hospital ED, which at the time, was seeing 40,000 visits per year with Press-Ganey scores in the 15th percentile. With USACS, the ED was able to grow its volume and improve its Press Ganey scores significantly In 2011, USACS was asked to manage and staff Pequot Medical Center, the hospitals free-standing 36,000 visits/yr ED. Shortly afterwards in 2012, USACS was once again asked to expand with the hospital by opening a Pediatric ED, staffed by board-certified PEM physicians. Presently in 2013, Lawrence Memorial has once again asked USACS to help them expand this time into The Westerly Hospital ED, which sees 26,000 patient visits/yr. The challenge during this period of rapid expansion has been building and maintaining a cohesive team while recognizing that each ED functions uniquely at an operational level.

The Solution

Each phase of expansion was different. The keys to successfully operating a single ED differ markedly from those required to effectively manage a system of four different EDs. Our first expansion to staffing the free-standing ED called for a made-to-order triage space, allowing double and triple simultaneous triage. This arrangement maximizes the efficiencies of USACS’ PhysicianFirst concept. By seeing patients sooner, the physician-in-triage is able to discharge about 20-25% of all ED volume directly from triage, reflecting the lower acuity and seasonal volume flux at the site. The second expansion involved the establishment of the first pediatric ED in Southeastern Connecticut. Historically, attracting fellowship trained pediatric emergency medicine trained physicians into the community setting has been difficult. The solution involved working with Yale New Haven Hospital to provide academic shifts, didactics, and a clinical affiliation with Yale to our pediatric ED physicians who are employed by USACS. In only one year, we have fully staffed our daily after-hours pediatric ED. Our newest challenge comes with another expansion of the medical system — this time across state lines with Westerly Hospital. USACS assumed management services on day one of the acquisition and has smoothed the way to prevent unnecessary turnover, gradually introduce USACS culture, and ensure the retention of physicians with the values-fit of USACS.

The Results

By effectively managing expansion within Lawrence & Memorial Hospital we were able to:

Results Quote


By maintaining flexibility and sharing a common vision, USACS and Lawrence & Memorial have been able to grow over the last six years from a collaboration on a single ED, to today, an operation consisting of four distinct EDs, which are successful within the same system. Especially apropos to the current trend towards healthcare systems, USACS’ culture of ownership and shared risk allows us to expand and adapt with the needs of our partner hospitals.

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