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ED Achieves Decrease to LOS, DC LOS, and Admit LOS

Case Study

The Challenge

Exeter Hospital, along the seacoast in Southern New Hampshire, had a long-standing relationship with a small, private EM group.

The hospital wished to improve their metrics, increase volume and improve their reputation within the community. The private EM group was resistant to implementing changes and was requiring financial assistance to maintain their current practice.

The Solution

Our EM Traveling Physicians allowed us to begin providing emergency services immediately. In addition, four physicians and two APPs from the previous group were retained. Additional emergencymedicine-trained, board-certified/board-eligible physicians were hired and trained. The group quickly became integrated into the hospital and is active in multiple committees.

By partnering with USACS and ECHO Consultants, we began improving operations and metrics. Base case data showed that the LWBS rate was more than 2%, and door-to-provider time was 85-minutes. Length of stay for discharge patients was 3-hours 17-minutes, and length of stay for admits was 5-hours 43-minutes. The initial priority was to decrease the LWBS rate.

Process improvements included the implementation of electronic order entry. Providers were ordering all testing – labs, imaging, EKG – on paper, which was handed to a unit secretary. The secretary transcribed the orders and entered them into the computer.

The ED began utilizing physician-in-triage while ECHO consultants improved throughput for discharged and admitted patients. As throughput times improved, direct bedding with bedside triage was implemented. Door-to-provider times decreased even more.

The Results


By partnering with ECHO, the hospital ED achieved a dramatic decrease with regard to overall LOS, DC LOS, Admit LOS.

Exeter Hospital - USACS Performance Metrics


Since the beginning of the partnership, many significant changes and improvements were made to the staff and operations at Exeter Hospital. By seeing patients faster and efficiently completing their work-ups, we have improved satisfaction of our patients as well as the quality of care that they are receiving.

The team of board-certified, emergency medicine physicians and APPs continues to embrace changes while improving the quality of patient care.


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