Time From Door to Diagnostic Evaluation by Health Care Provider

Door-to-evaluation time is defined as the time from when a patient arrives at the emergency room (ER) to his or her first personal interaction with a health care provider. Reducing patient wait time in the ER helps improve patients’ access to care. Decreased wait times may reduce the number of patients leaving without being seen, decrease delays in getting medications to patients, and lessen patient suffering.

What is this measure?

doctor with pediatric patient holding tongue depressor

This measure was created to reduce the time children spend in the emergency room before they are seen by a health care provider.

Examples of health care providers include physicians, nurse practitioners, certified nurse specialists, physician assistants, certified nurse midwives, certified registered nurse anesthetists, clinical social workers and physical therapists.

Johns Hopkins strives to keep patients’ waiting time as short as possible. Reducing patients’ wait times would lower the number of patients and their parents or caregivers who are leaving the emergency room without being treated.

Why is it important?

Patients who are able to see a health care provider quickly when they arrive to an ER are less likely to leave without receiving proper medical care. This quick, initial assessment is performed so that patients with the most serious or life-threatening cases are seen first. A quick and accurate initial assessment decreases delays in receiving medication and can make patients more comfortable.

What is Johns Hopkins doing to improve?

Emergency rooms do not follow a schedule. Patient traffic is unpredictable and often fluctuates, potentially leading to longer wait times. At Johns Hopkins Medicine, we are committed to successfully managing the unpredictable surges by carefully reviewing the overall patient volume and movement across all our pediatric emergency rooms. This includes an ongoing analysis of the number of patients we see every month, updating staffing where necessary, and evaluating our ability to manage the arrival of patients.

We also review best practices from other hospitals to determine how we can be most efficient to ensure that our emergency rooms are moving as smoothly as possible.

Frontline Perspective

Vicki MinorVicki Minor, Sheila Hofert and their entire pediatric unit strive to provide great patient care that comes from the heart.

Vicki Minor, M.S.N., R.N.-C.
Patient Care Manager III
Pediatric Combined Unit
Neonatal Intensive Care
Johns Hopkins Bayview Medical Center

“When a patient first walks through our doors, there are many things that need to happen until he or she is seen by a health care provider. It is truly a team effort to make sure this waiting time is as brief as possible. The director of our pediatric unit, Dr. Sheila Hofert, and I are champions for keeping the wait time as short as possible.

I think open communication has been the key to reducing the patient’s waiting time. In addition to educating the staff and doctors as to why we care about how long patients wait, we also review our performance as a group daily, weekly and monthly to keep this issue at the forefront and to make sure we stay on track. The communication between the nurses and doctors is also critical to streamline the registration process. Our nurses can often start care by giving fever-reducing medications or ordering X-rays to keep things moving.

And of course, we make sure that the doctors and nurses are actively communicating with our patients and their families to acknowledge any potential wait times and to assure them that we will see them as soon as we can. Our medical students are a great help in speaking with our patients and their families to determine what’s going on and to listen to their concerns.

I am proud of our efforts to reduce the wait time in our department and enjoy seeing the results of our teamwork.

As Dr. Hofert says, ‘The biggest reward in our jobs is knowing we are taking good care of our patients as quickly as possible, helping to ease their pain, seeing them get better and hopefully making them laugh sometime during their stay with us.’”

How can patients and family support safety?

  • Be prepared to describe your child’s problems and your concerns as clearly as possible to the health care provider. It may be helpful to write them down.
  • When you visit the emergency room, stay in touch with your pediatrician so that he/she is aware of the ER visit and can provide follow-up care, if needed.
  • Be a “patient” consumer. Please be aware that the doctors and staff members in our emergency departments work hard to see you as quickly as possible. To help pass the time for you and your child, bring coloring books or other fun distractions.

Quality and Safety Performance During COVID-19

The organization’s quality and safety performance may have been impacted by the COVID-19 pandemic. We would urge patients to consider more recent performance in combination with historical performance. Patients may benefit from discussing with their healthcare provider the disruptions COVID-19 may have caused on quality and safety of care.

See how Johns Hopkins Medicine prioritizes safety during the COVID-19 pandemic.