Emergency Severity Index of AHRQ Shortens Waiting Time at Hillcrest’s Emergency Department

Rationale / Objectives

The increase of Emergency Department (ED)’s visits caused long waiting time for patients. The longer the patients waited in ED, the higher chance they could have life-threatening or permanent damage. Hillcrest Hospital wanted to eliminate the waiting time and assure that patients were accessed in timely manner.

Project/Program Description & Major Achievements

Hillcrest Hospital expanded its ED to accommodate more than 50% of visits. Moreover, the split-flow model, complemented with Emergency Severity Index (ESI) significant boosted patient satisfaction and reduce waiting time in ED.

Lessons Learned

All ED staff needed to receive proper training about ESI. By communicating in the same ESI language, Hillcrest could keep track accurately the appropriate duration of stays and patient’s arrangement.

Further Description

Hillcrest Hospital is a full-service hospital that serves the medical needs of Mayfield Heights and the surrounding communities including Lake and Geauga counties 2. To care for the growing needs of the community, the new Emergency Department (ED) has increased from 10,000 square feet to 40,000 square feet. It is equipped to accommodate 68,000 adult and pediatric ED visits in 2010, compared with the former ED which was designed for 25,000 visits 3. A unique feature of the Emergency Department involves keeping patients who are non-critical moving through the department. Those patients are sent toan intake room where they are assessed by a nurse and seen by a doctor. This process, known as a split-flow, separates critical and non-critical patients, allowing those who are less urgent to be seen more quickly and freeing up space for those who have a severe injury or illness 2.  The split-flow process removes waiting time and the need for patients to be examined more than once. . All patients are seen more quickly,, with the relevant providers attending to each patient. This model improves patient satisfaction and decreases wait times considerably.3

Major Achievements

The split-flow model along with ESI has significantly decrease waiting times of Hillcrest’s patients compared with national average.



Additional Detail

Average time patients spent in the emergency department before they were seen by a healthcare professional

13 minutes lower than national average

Centers for Medicare and Medicaid Services (2014)

Percentage of patients who left the emergency department before being seen

50% lower than national average