Throughput
Patient flow reflects how well an organization works together.
Throughput isn’t owned by a single department. It is created at the intersection of emergency medicine, hospital medicine, nursing, case management, utilization review, consultants, and hospital administration.
CVCCM’s ability to lead multiple service lines allows us to redesign workflows across departmental boundaries—rather than improving one service while creating delays in another.
Throughput reflects the entire patient journey—from arrival in the emergency department through admission, inpatient care, and ultimately discharge.
Improvement begins by identifying where patients stop moving and why.
The answer may be an ED workflow, delayed admission decisions, consultant engagement, discharge processes, communication between departments, or unclear expectations between physicians.
We bring the people responsible for those decisions together, identify the barrier, and build a practical solution around it.
One of the greatest opportunities occurs at the transition from emergency to inpatient care.
Time to Admit measures how efficiently patients are evaluated and admission decisions are made. Bed Hold Time reflects what happens after that decision—how efficiently the hospital moves the patient into inpatient care.
Different metrics. Same patient. Same hospital.
Improving either requires shared expectations between emergency physicians, hospitalists, nursing, and hospital operations.
The Proof
At one hospital, emergency physicians identified inconsistent communication and unnecessary variation in how admission requests were handled between the ED and inpatient teams.
Physician leadership brought emergency medicine, hospital medicine, and hospital administration together to create a standardized admission workflow.
Every admission request received one of three responses within 30 minutes:
- Accept the patient.
- Request clinically relevant information—with a clear rationale.
- Recommend transfer—with a documented clinical reason.
The workflow was formally adopted into the group’s Standard Operating Policies and Manual and supported by a defined escalation pathway.
Making the Workflow Work
A 30-minute standard means little if physicians don’t have a shared understanding of what should—and should not—delay an admission.
Through physician-led education and case review, we identified testing that truly influenced disposition versus testing that could safely continue after admission. We also established guidance for patients whose need for tertiary transfer remained uncertain.
The goal wasn’t simply to move patients faster. It was to remove unnecessary waiting without compromising clinical judgment.
Continuous Input
We continuously review Decision-to-Admit and Time-to-Admission data to identify recurring barriers.
When delays occur, we look behind the number: Was the ED evaluation incomplete? Was the inpatient response delayed? Were admission expectations unclear?
The data isn’t used to assign blame. It’s used to find the next problem worth solving.