Abstract
Prolonged discharge patient encounter length of stay (LOS) in emergency departments (ED) contributes to overcrowding, delayed care, and increased costs. This Quality Improvement (QI) project was initiated at a community, 42-bed Emergency Department that services approximately 75,000 patients annually to address the baseline average discharge LOS of 294 minutes from January 2024 - August 2024. The organizational goal for these discharged patients sits at 165 minutes. The project’s aim was to reduce discharge LOS by implementing structured TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) huddles to enhance communication, optimize patient flow, and improve throughput efficiency.
This project was framed using Roger’s Five-Stage Change Theory within a Plan-Do-Check-Act (PDCA) model over a six weeks period. Stage 1 involved in-person education with Charge Nurses and Nurse Leaders to introduce the huddle process. Stage 2 provided ongoing support and persuasive communication to encourage adoption. Stage 3 initiated a soft pilot, where compliance data and trends were shared with staff. Stage 4 was a hard rollout with weekly data monitoring and compliance tracking. Stage 5 established sustainability by incorporating huddles into the Charge Nurse role as a required responsibility. Stakeholders, including charge nurses and Operations Administrators, monitored compliance and throughput metrics weekly.
The intervention led to measurable improvements in discharge LOS. At the start of the project, LOS averaged 244 minutes. By Week 3, LOS improved to 219 minutes, the lowest recorded during the project. Adjustments during the PDCA cycle refined processes to better align with workflows, stabilizing LOS at an average of 227 minutes in the final weeks. Overall, the project reduced the average discharge LOS to 232 minutes, an improvement from the baseline of 294 minutes, though it did not meet the 165-minute target.
This project highlights the impact of structured communication strategies on ED efficiency. Even with elevated patient volumes during implementation, averaging 232 patients daily compared to the annual average of 195, the intervention reduced discharge LOS. These findings emphasize adaptability and interdisciplinary collaboration as key factors in sustaining improvements. For emergency care leaders, this initiative offers a model for addressing patient flow challenges while maintaining high-quality care delivery.
Notes
References:
Blake, P. G., & Bacon, C. T. (2020). Structured rounding to improve staff nurse satisfaction with leadership. Nurse Leader, 18(5), 461-466. https://doi.org/10.1016/j.mnl.2020.04.009
Burgess, L., Ray-Barruel, G., & Kynoch, K. (2022). Association between emergency department length of stay and patient outcomes: A systematic review. Research in Nursing & Health, 45, 59–93. https://doi.org/10.1002/nur.22201
Huddle: Aha teamstepps video toolkit: AHA. American Hospital Association. (2024). https://www.aha.org/center/project-firstline/teamstepps-video-toolkit/huddle
Hassan, A. E., Mohammed, F. A., Zakaria, A. M., & Ibrahim, I. A. (2024). Evaluating the effect of TeamSTEPPS on teamwork perceptions and patient safety culture among newly graduated nurses. BMC Nursing, 23(1), 170. https://doi.org/10.1186/s12912-024-01850-y
Lee, K., Jang, K., Kim, H., Bae, G., Jang, C. S., & Shin, J. H. (2023). Factors affecting the length of stay in the emergency department in psychiatric emergency patients in the COVID-19 pandemic context. INQUIRY: The Journal of Health Care Organization Provision and Financing, 60. https://doi.org/10.1177/00469580231167529
Matzke, C. M., DeGennaro, R., & Howie-Esquivel, J. (2021). Incorporating TeamSTEPPS training to improve staff collaboration in an academic level I emergency and trauma center. International Emergency Nursing, 55, 100959. https://doi.org/10.1016/j.ienj.2020.100959
Obenrader, C., Broome, M. E., Yap, T. L., & Jamison, F. (2019). Changing team member perceptions by implementing TeamSTEPPS in an emergency department. Journal of Emergency Nursing, 45(1), 31-37. https://doi.org/10.1016/j.jen.2018.08.006
Pimentel, C. B., Snow, A. L., Carnes, S. L., Shah, N. R., Loup, J. R., Vallejo-Luces, T. M., Madrigal, C., & Hartmann, C. W. (2021). Huddles and their effectiveness at the frontlines of clinical care: A scoping review. Journal of General Internal Medicine, 36(9), 2772-2783. https://doi.org/10.1007/s11606-021-06632-9
Rowan, B. L., Anjara, S., De Brún, A., MacDonald, S., Kearns, E. C., Marnane, M., & McAuliffe, E. (2022). The impact of huddles on a multidisciplinary healthcare teams' work engagement, teamwork and job satisfaction: A systematic review. Journal of Evaluation in Clinical Practice, 28(3), 382-393. https://doi.org/10.1111/jep.13648
Singer, A. J., Thode, H. C., Jr., Viccellio, P., & Pines, J. M. (2011). The association between length of emergency department boarding and mortality. Academic Emergency Medicine, 18(12), 1324-1329. https://doi.org/10.1111/j.1553-2712.2011.01236.x
Sigma Membership
Zeta Pi
Type
Poster
Format Type
Text-based Document
Study Design/Type
Quality Improvement
Research Approach
Translational Research/Evidence-based Practice
Keywords:
Interprofessional, Interdisciplinary, Instrument and Tool Development, Interprofessional Initiatives, Leadership, Leadership Initiatives, Length of Stay, Emergency Departments
Recommended Citation
Monsivais, Joshua S., "Huddle Up! A Quality Improvement Project to Improve Discharge Length of Stay" (2025). Biennial Convention (CONV). 87.
https://www.sigmarepository.org/convention/2025/posters_2025/87
Conference Name
48th Biennial Convention
Conference Host
Sigma Theta Tau International
Conference Location
Indianapolis, Indiana, USA
Conference Year
2025
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2025-12-09
Huddle Up! A Quality Improvement Project to Improve Discharge Length of Stay
Indianapolis, Indiana, USA
Prolonged discharge patient encounter length of stay (LOS) in emergency departments (ED) contributes to overcrowding, delayed care, and increased costs. This Quality Improvement (QI) project was initiated at a community, 42-bed Emergency Department that services approximately 75,000 patients annually to address the baseline average discharge LOS of 294 minutes from January 2024 - August 2024. The organizational goal for these discharged patients sits at 165 minutes. The project’s aim was to reduce discharge LOS by implementing structured TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) huddles to enhance communication, optimize patient flow, and improve throughput efficiency.
This project was framed using Roger’s Five-Stage Change Theory within a Plan-Do-Check-Act (PDCA) model over a six weeks period. Stage 1 involved in-person education with Charge Nurses and Nurse Leaders to introduce the huddle process. Stage 2 provided ongoing support and persuasive communication to encourage adoption. Stage 3 initiated a soft pilot, where compliance data and trends were shared with staff. Stage 4 was a hard rollout with weekly data monitoring and compliance tracking. Stage 5 established sustainability by incorporating huddles into the Charge Nurse role as a required responsibility. Stakeholders, including charge nurses and Operations Administrators, monitored compliance and throughput metrics weekly.
The intervention led to measurable improvements in discharge LOS. At the start of the project, LOS averaged 244 minutes. By Week 3, LOS improved to 219 minutes, the lowest recorded during the project. Adjustments during the PDCA cycle refined processes to better align with workflows, stabilizing LOS at an average of 227 minutes in the final weeks. Overall, the project reduced the average discharge LOS to 232 minutes, an improvement from the baseline of 294 minutes, though it did not meet the 165-minute target.
This project highlights the impact of structured communication strategies on ED efficiency. Even with elevated patient volumes during implementation, averaging 232 patients daily compared to the annual average of 195, the intervention reduced discharge LOS. These findings emphasize adaptability and interdisciplinary collaboration as key factors in sustaining improvements. For emergency care leaders, this initiative offers a model for addressing patient flow challenges while maintaining high-quality care delivery.
Description
Gather around and discover how a structured huddle reduced emergency department discharge length of stay (LOS). This quality improvement project highlights innovative approaches to enhance patient flow, improve throughput efficiency, and address operational challenges. Join us to explore actionable insights and a model for improving ED efficiency while maintaining high-quality care delivery.