The emergency department at Texas Health Harris Methodist Hospital in Fort Worth is a different breed of emergency department. This can be felt upon entering the beautiful facility through the patient entrance. The greeter area is a stunning architectural space that is quiet, uncluttered, and welcoming. Filled with art and natural light (with attractive furniture on gleaming granite floors), the space is calming and invites patients to be seen. This waiting room serves more as a lobby and is meant for families, not patients. The fact that it was nearly empty every time we passed through it was testimony to the efficient operations within.

The patient entrance/waiting room at Texas Health Harris Methodist Hospital.

Texas Health Fort Worth by the Numbers

• Annual census: 123,000
• Beds: 100
• Admission rate: 24 percent
• Ambulance arrivals: 30 percent

An “all hands on deck/patients first” imperative is imbedded into the culture and is almost palpable. The Texas Health Fort Worth ED has a long legacy of excellent teamwork, communication, cooperation, and overall effectiveness. The department is almost continuously trialing improvements, and this continuous “change culture” has bred amazing innovation. It has a systematic process for the rollout and trial of changes in the department that heavily involves the input of frontline physicians and staff. The ED gives almost every initiative a six-week opportunity to succeed, and as a result, they are enjoying a decades’ worth of improvement. Patient flow and workflow processes are not static. The department is always trying to improve. Some initiatives have not worked, but many have, and these changes added to the already-efficient operations in the Texas Health Fort Worth ED.

The ED boasts unrivaled performance in both clinical and operational metrics. Most of their Core Measures metrics (pneumonia, stroke, ST elevation myocardial infarction, sepsis) had performance at above 95 percent, with many at 100 percent. Further, its operational performance is unheard of in EDs seeing more than 100,000 patients a year.

Texas Health Fort Worth Performance Metrics

• Door to doc: 20 minutes
• Overall length of stay: 185 minutes
• Length of stay for admitted patients: 291 minutes
• Left without being seen: 1.4 percent

What are some of its strategies for such outstanding workflow, patient flow, and clinical quality? It begins with a very efficient intake process using traditional nurse triage. This process is abbreviated and takes fewer than five minutes with rapid bed placement. There is capacity for the triage of 10 patients at once, and though I like physician triage preferentially, if traditional nurse triage is abbreviated, resourced, and staffed properly, it can be a very effective intake model. It clearly is effective as it has been implemented at Texas Health Fort Worth.