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Excellence in the ED: Sustaining High-Performing Teams and Impressive Metrics

Case Studies

A 2023 report ranked Delaware as the state with the second longest emergency department (ED) wait times in the country, with an average of 215 minutes from arrival to movement to a treatment area. Other important benchmarks such as left without being seen (LWBS) rates and patient satisfaction scores suffer in relation. However, Saint Francis Hospital in Wilmington, Delaware, stands contrary. With an existing focus on efficiency, the facility’s ED weathered the COVID-19 pandemic with limited noticeable changes in key performance metrics. Furthermore, the team has returned to – and in fact, strengthened beyond – pre-pandemic performance and now looks ahead to sustain their success.


Sustaining Care Excellence

Saint Francis and TeamHealth enjoy a long-standing partnership in emergency and hospitalist medicine. The firm foundation shines in the emergency department’s continued performance success and reputation for care excellence. To sustain this success, the team keeps a sharp focus on process, personnel and culture.


The hospital experiences shifting patient volumes, sometimes dramatic fluctuations from 60 to over 100 patients per day that could derail a less defined process and team from achieving high performance. However, the Saint Francis team has refined their protocols to adapt to their daily needs. TeamHealth’s proprietary clinical analytics platform Cognition likewise affirmed the observed patterns, and the Clinical Analytics team helped perform an analysis on key metrics.

The group effectively flexes up or down on the busiest and slowest days. This helps significantly to match staffing resources on census days that can vary between 60 and 105 patients per day. – Dr. Bruce Nisbet

Whenever available, the ED uses a direct-bed model that reduces wait times. The emergency and hospitalist teams are also integrated TeamHealth services, and the partnership between the high-performing departments is collegial and supportive. The enhanced performance in the inpatient unit improves the flow of patients through the ED, as the team experiences limited bed holds. This collaborative effort is made possible by the dedicated teamwork within and across the departments.

The TeamHealth hospitalists and emergency medicine physicians really get on well. There exists a mutual appreciation for what we do and are on the same page; this collegiality makes shifts more gratifying and works to optimize patient care. – Dr. Bruce Nisbet


The team approach is the cornerstone of the ED’s success. Powerful recruitment and retention mean the hospital has a dedicated and highly skilled team across nursing, advanced practice clinicians and physicians. Consistency in action across all clinical staff brings a grounded approach to the process that allows the ED to function with stability and unity. The partnership between the nursing staff and TeamHealth clinicians is particularly strong, and this strength enhances the team’s culture of cooperation, communication and investigation. In addition, the team and partner departments have ongoing educational opportunities that includes nurses and technicians. For example, the OB/GYN department chair recently engaged the team and soon a pediatric emergency physician will visit for more educational opportunities.

Being a relatively small department with about 20 patient rooms, everyone works together and gets to know each other. This familiarity combined with the ease of communication given the department’s size, aids greatly in patient care. – Dr. Bruce Nisbet


Emergency medicine can be a daunting discipline. However, the Saint Francis team functions without the cynicism that sometimes creeps into the specialty. Each team member brings positivity and collegiality to the departmental culture. Though the demands of emergency healthcare can be quite challenging, the team enjoys shared company and experiences that create a healthy culture in the department. They all want patients seen as quickly as possible and to provide excellent care. What’s perhaps most notable is the communication and problem-solving among the team. Whenever a problem or challenge arises, the team works through it together to find the most fitting solutions and processes to implement consistently within the ED.

The Results

Even amidst the COVID-19 pandemic, the facility maintained exceptional performance metrics. The team has seen metrics return to pre-pandemic levels quickly, with particularly impressive year-to-date successes:

  • Consistently low LWBS rates, with an annual record-low of just 0.9% as of July 2023 and five consecutive months with rates under 2%
  • Median D2D times well under the state and national benchmarks, with a 2023 median of 21 minutes as of July
  • Median discharge LOS consistently tracking under 120 minutes, compared to national peer facility benchmarks exceeding 160-minute averages

The Conclusions

With a consistently high-performing team, the mutual successes continue as the team maintains impressive metrics and patients get the care they need when they need it. The ongoing relationship between Saint Francis and TeamHealth, along with the sustained successes, show the benefit of forging valuable, collaborative partnerships in this space. Our breadth and depth of skill in hospital-based services uniquely position our teams to strengthen and maintain performance and care in facilities across the country. Learn more about partnering with TeamHealth by connecting with us today.


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