Across the nation, high-volume emergency departments are finding new ways to improve efficiency without sacrificing patient experience or quality care.
EDs are continuing to face challenges in patient wait times, boarding and patients leaving without being seen.
- An August study found that more than 17% of admitted patients boarding in the emergency department, or about 85,000, went at least four hours with no inpatient team managing their care. Nearly 23,000 waited 12 hours or more, and about 4,500 waited 24 hours or longer.
- The national average showed 2% of patients left EDs before being seen in 2024, the most recent CMS data. Only 11 states had a rate of 1%.
- Nationwide, the median time patients spent in the ED — excluding psychiatric/mental health patients and those transferred to another facility — was 162 minutes, stable from the same period a year prior, according to CMS data.
On Aug. 6, the Emergency Nurses Association awarded 126 EDs with the 2026 Lantern Award, which recognizes EDs that excel to meet challenges, including ED boarding, improving pediatric readiness and enhancing nurse professional development.
Becker’s reached out to several of these awarded EDs to find what programs have most improved ED efficiency in the past year, and the changes that helped them get there.
Editor’s note: Responses have been lightly edited for length and clarity.
Danielle Brown-Kleppe, BSN, RN. Director of Emergency Services at Kaiser Permanente Roseville (Calif.): Two areas where this work has made a meaningful difference are ambulance arrivals and the creation of a dedicated space for pediatric emergency care. When patients arrive by ambulance, getting them safely and quickly into the appropriate treatment area is an important part of delivering timely emergency care. Through close collaboration among physicians, nurses, support staff and emergency response partners, our teams manage ambulance arrivals effectively and efficiently. Our work in this area translates to continuously reduced offload time, helping patients receive care sooner while allowing EMS crews to return more quickly to serving the community. In our dedicated space to care for our pediatric patients, we have enhanced and streamlined the way our patients receive care. The child-friendly space has eight rooms with an under-the-sea theme that are tailored to meet the needs of children to help them feel more at ease and comfortable with treatment. This pediatric pod brings together a team of pediatric specialists who deliver the right care in the right setting to meet the health care needs of our pediatric patients and their families.
In a high-volume ED, success is measured by our ability to connect patients with the right care at the right time. That means creating an environment where care teams can focus on what they do best, resources are available when and where they are needed, and patients receive timely, high-quality care.
Brandie Cherry, RN, BSN. Director of Emergency Services at Kaiser Permanente Sacramento (Calif.): Through July 2026, Kaiser Permanente Sacramento’s Emergency Department cared for nearly 68,000 patients, averaging more than 320 patients per day. By strengthening care coordination and streamlining how patients are connected to the services they need, we consistently deliver high standards of quality, safety and care experience. A key contributor has been our integrated approach to care, which brings together physicians, nurses, care teams and hospital leaders to help patients move more seamlessly through their care journey. This combines standardized processes for moving patients into the appropriate level of care, stronger collaboration between the ED and hospital operation teams and expanding alternative care options for treatment and discharge. Through real-time operational awareness, strong teamwork, and a culture of continuous improvement, we are keeping patient care, quality and safety at the center of everything we do.
Gale Kinder, RN. Director of Emergency Services at Piedmont Athens (Ga.) Regional Medical Center: One of the most impactful improvements our ED achieved in the past year was the implementation of a nurse-led EMS Triage process during periods of high patient volume. With increasing EMS arrivals and a shared commitment to returning ambulance crews to their communities as quickly as possible, we recognized the need for a more efficient approach to receiving EMS patients. To address this, we assembled an interdisciplinary team and developed a standardized activation process with clear communication pathways and defined operational triggers. The process included real-time tracking, proactive coordination by the charge nurse, dedicated equipment and stretcher availability, streamlined EMS-to-ED handoff communication, and secure messaging among key members of the care team. Our goal was to transfer EMS patients to ED care and return ambulance crews to service within the state’s 20-minute benchmark.
The results were significant. Nurses were better prepared for EMS arrivals, ambulance turnaround times improved, and charge nurses were able to continue moving waiting room patients into treatment spaces without interruption. We also saw a reduction in our Left Without Being Seen rate as bed placement became more efficient. Most importantly, the initiative enhanced teamwork, improved patient safety, reduced wait times and elevated the overall patient experience.
Kerry Major, MSN, RN. Vice President and Chief Nursing Officer for Cleveland Clinic’s Florida Market: We did some work related to blood cultures and low-volume blood culture rates. Low volume can impact our testing efficacy and can lead to false negative results. So it’s really important that we have the right volume in those blood culture bottles to allow for a seamless plan for the patient and make sure the treatment plan is appropriate. It also impacts patient satisfaction and length of stay in the ED, because we don’t want to have to redraw the patient, resend the lab work, and wait again for the results. We pulled together a multidisciplinary team to address the opportunity using a continuous improvement framework.
At the beginning of last year, our low-volume blood culture rate was approximately 41%, which is very high. The team used real-time performance data to target education, hold staff accountable and partner with the lab for ongoing monitoring of the metrics and real-time feedback. As a result, we reduced the rate from 41% to below 15% in one year.
Wendi Sears, RN, chief nursing officer at Banner Estrella Medical Center (Phoenix): Banner Estrella Medical Center serves nearly 82,000 patients a year in the emergency department, and for 2025 the rate of patients leaving without treatment dropped below the national average to nearly 1%. The change can be attributed to the hospital’s Accelerated Care Experience project, which was launched after COVID-19. It helped achieve these results through comprehensive redesign of emergency department processes, reducing delays and ensuring rapid clinical contact with patients. The initiative also introduced earlier diagnostic initiation, increased communication and more frequent rounding, which have helped to reduce idle time and uncertainty and improve the patient care experience from the moment someone walks through our doors up until discharge.
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