Enhancing Patient Throughput Through Front-end Redesign and Alternate Care Space Implementation in a Pediatric Emergency Department: A Quality Improvement Initiative.

Introduction: Emergency department (ED) crowding remains a persistent national challenge, contributing to delays in care, increased length of stay (LOS), and higher rates of patients leaving without being seen (LWBS). Front-end strategies improve throughput and reduce LWBS by enabling earlier assessment and disposition. Building on prior efforts, this quality improvement initiative aimed to enhance patient flow for low-acuity pediatric patients by leveraging alternative care spaces to reduce roomed-to-disposition time, LOS, and LWBS while preserving capacity for higher acuity care. Methods: This initiative occurred in a high-volume pediatric ED using a front-end, physician-driven "Intake" model. To improve efficiency and throughput, the team introduced an alternate care space. Additional interventions included role clarification, workflow standardization, and targeted education for physicians and staff to reduce roomed-to-disposition time for Intake patients by 10% within 4 months. Results: Roomed-to-disposition time for all Intake patients decreased by 15% (from 88 to 75 min), whereas a specific group of low-intervention patients experienced a 49% reduction. LOS for all Intake patients decreased by 30%, and by 48% for low-intervention patients (from 286 to 148 min). Additional improvements included a 49% reduction in LWBS and a 37% decrease in arrival-to-provider time. Conclusions: Our quality improvement initiative demonstrated that a thoughtful reorganization of existing ED Intake processes, without additional staffing or physical expansion, can meaningfully improve patient throughput, provider efficiency, and overall ED performance.