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Metrics: St. Elizabeth Hospital, Enumclaw, WA

Case Studies


St. Elizabeth Hospital was challenged with a shortage of both emergency department (ED) and inpatient beds. Due to space constraints, outpatient procedures were being performed in the ED, further reducing its capacity. These constraints, compounded by growing patient volumes, resulted in long wait times and a growing number of patients who left without being seen (LWBS).


When the hospital realized its declining metrics posed a potential patient safety risk as well as lost revenue, it turned to TeamHealth for help.

The ED leadership kicked off the process by forming a multi-disciplinary performance improvement team and training them in LEAN healthcare strategies. After specifying targeted patient safety goals and metrics, the team designed a patient-centric flow plan that streamlines the patient flow process, eliminating all steps that do not add value to the patient. The resulting design was a “split-flow” model that builds efficiencies through:

  • Quickening front-end processes (triage and registration)
  • Segregating flow processes for vertical and horizontal patients (sick vs. not sick)
  • Hardwiring teamwork (physician and nurse conducting joint assessments and discharge)
  • Promoting flow (creating a results waiting area


The hospital achieved immediate and significant improvements in metrics with the new flow process. The hospital also realized unanticipated benefits, such as improvements in turnaround times for imaging and lab results.The most important success was improved patient safety. Without reducing thoroughness, the team eliminated waste and improved processes that allowed them to expedite care to patients. As a result of this commitment to patient safety, the hospital was awarded the William O. Robertson Patient Safety Award from the Washington State Medical Association.


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