This article discusses three ways in which dramatic improvements in middle flow, or examination-to- disposition time, can be driven by emergency department (ED) nursing leadership. By operationalizing a “results pending” area, low-acuity patients who are unlikely to be admitted can await diagnostic results or be actively monitored by a dedicated nurse, ED rooms and beds may be reserved for higher acuity patients. Monthly operational stakeholder meetings can provide a consistent opportunity to track, monitor, and improve flow while also celebrating successes and identifying needed performance improvements based on objective metrics for shared goals. Internal customer rounding is a process that serves as effective follow-up from the stakeholder meeting to ensure aligned behaviors tomeet identified goals. Frequency of rounding is identified during the stakeholder meeting. By using these three tools, ED stakeholders can effectively focus on solutions instead of barriers to improving middle flow.
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