Leaders from some of the top hospitals for emergency department excellence are sharing their low-lift processes and practices that helped them earn national honors.

In July, the Emergency Nurses Association recognized 96 hospital emergency departments for demonstrating outstanding leadership, practice, education and advocacy that resulted in improved patient care and staff well-being. The Lantern Awards have been handed out annually since 2011 and are awarded based on evidence-based practices and innovation in emergency care.

Here are some of the practices that helped these hospitals achieve excellence:

Editor’s note: Responses have been lightly edited for length and clarity.

Benjamin Abella, MD. Chair of the Department of Emergency Medicine at Mount Sinai Health System (New York City): We’re very proud of our teams at Brooklyn and Queens for achieving this level of success. One of the ingredients to our success is having, especially on the nursing side, very active, engaged midlevel leaders who are present on the ground, working alongside and supporting the teams. When staff feel that support, they rise to the challenge, work harder and provide better care. Emergency medicine is a tough front-line job. The shifts are stressful, patient loads are heavy and the problems are many. People rise to the occasion when they feel supported and when they see leadership on the ground with them, listening to their problems and helping solve them.

Diane Amado-Tate, DNP, RN. Chief Nursing Officer at Baptist Health Doctors Hospital (Coral Gables, Fla.): One of the most effective strategies we’ve implemented to elevate ED performance is embedding service and compassion-focused behaviors into the foundation of our care model. While clinical excellence is essential, we place equal value on how that care is delivered. Our goal is to ensure patients feel respected, heard and supported during their most vulnerable moments. This approach includes consistent empathy-based communication training across all levels of ED staff. As a result, we’ve created an environment where patients often share that they felt like family. Our culture of compassionate care is reinforced by a strong focus on professional development. We encourage nurses to pursue advanced degrees and specialty certifications and actively support their involvement in research and practice innovation.

Shannon Christian, MSN, RN. Chief Nursing Officer and Senior Vice President of Patient Care Services at Lawrence + Memorial Hospital (New London, Conn.) and Westerly (R.I.) Hospital: Achieving excellence in the ED required a multi-disciplinary, teamwork approach, including collaboration with Nursing Professional Governance. A primary focus was to improve communication when ED staff transferred patients to inpatient staff. At the time, ED staff would verbally relay information to the inpatient nurses, resulting in a lack of consistent reports and lack of staff availability to deliver and receive the report in a timely manner, impacting patient safety.

We researched best practices at the other hospitals in our health system and discussed with our teams which method would work best at our local delivery network. The consensus was to implement a handoff through the electronic health record. A template was created to ensure the ED staff provided information required by the inpatient staff in an easy to document format and in a timely manner. Once the solution was created, Nursing Professional Governance council members provided education to appropriate staff, as well as rounding on units, discussion with managers and clinical coordinators and drop-in training at the change of shift to walk through the template and answer questions.

Teams also created group chats through Epic Secure Chat, offering a seamless, efficient clinical communication solution which includes calling, individual and group messaging, broadcast messages and alerts. Secure Chat is a huge communication win among the teams. No phone calls, no overheads, no finding team members. By empowering and engaging our teams to drive decisions that impact their workflows and practice, they will achieve the same expected outcomes to better the experiences of our patients.

Brett Clarke, BSN, RN. Senior Director of Nursing for Cleveland Clinic Martin North Hospital and Cleveland Clinic Martin South Hospital (Stuart, Fla.): We wanted to look at ease of access to care — how quickly we’re seeing and treating our patients. First, we focused on the waiting room and adjusted our staffing model. We took the approach of flexing caregivers into the waiting area as volume dictated, and shifted much of our team from the back of the ED to the front. When a patient arrives, we do a quick registration, room them immediately and get them seen right away. Our goal is arrival-to-room in less than two minutes, and year to date, both North and Tradition [hospitals] have met that goal.

We also implemented a split-flow model. In the ED, some patients are high-acuity emergencies that take longer, while others don’t require immediate, complex care. Our split-flow model designates staff for high-acuity patients and a separate team for lower-acuity patients. That way, the lower-acuity patients are seen just as promptly and can often be discharged much faster.

Since deploying these models, we’ve seen a drastic reduction in left without being seen, and are now at 2.4%, well below the national average. We also saw double-digit improvements in patient perception of ease of access.

Nicole Crocker, MSN, RN. Vice President and Chief Nursing Officer; and Eric Allen, MSN, RN. Director of Emergency Nursing at AdventHealth Altamonte Springs (Fla.): Our success is really about real-time monitoring. We review what we call the “four Ds” — door to doctor, door to discharge, admit decision to depart, and door to departure — which make up our throughput and how quickly things are moving in the ED. Every four hours charge nurses run the report, which is reviewed by the director of the ED, nurse manager and any assistant nurse managers on duty. That way, everyone knows where we’re at and what progress we need to make in the next four hours to hit our goals and ensure we’re delivering the best possible care in real time.

When we look at capacity, the foundation is making sure every area is engaged and successful, always keeping the patient at the center. From the moment they hit the front door, it’s about being intentional — registering them, moving them quickly to a bed if available, capturing every need they have. Throughput also means recognizing the impact of ED borders. If patients are boarding, you can’t process new arrivals. So it’s about the whole campus functioning as one team to serve patients.

That’s why the real-time, four-hour data check is so important. It shows what’s going well and where opportunities are. We address issues in real time, whether it’s an overcapacity alert or patients waiting an hour to be seen. Everyone wants to do the right thing; it’s about helping them see where we can do better.

Steven Moss, BSN, RN. Director of Emergency Services at Orlando Health-Health Central Hospital (Ocoee, Fla.): One of our major goals has been to reduce the number of people leaving the ED before being seen. It was a team effort to take on this project, involving not only the ED clinicians, but also our allied partners in areas like registration, security and environmental services. Together, we enhanced the ED space utilization and traffic flow to get patients into their rooms faster and more efficiently. Some of our strategies included increasing operational capacity, fast tracking low acuity patients to make additional space for sicker patients, direct bedding when possible, and developing and implementing standard operating procedures. The involvement of the team members in the redesign of the physical space and mapping out of the future patient flow provided the team with the ability to be creative and utilize their innovative skills. These efforts resulted in a 45% decrease in ED exits from FY23 to FY24.

Paul Mungo, MSN, RN. Chief Nursing Officer at Baptist Health South Miami Hospital: Our ED implemented a fast-track triage model to improve flow and elevate the patient experience. During peak hours, a provider and nurse team staff a dedicated space for ESI 4 and 5 patients, allowing triage nurses to initiate protocol-driven care including pre-approved labs and imaging. To further support this effort, the team adopted a continuous patient flow strategy, moving patients directly into available rooms, increasing staffing during surges and providing regular updates to manage expectations. Together, these initiatives have shortened door-to-provider times, reduced overall length of stay and strengthened both patient and staff satisfaction.

Stacy Sweeney, RN. Nurse Manager for the Cleveland Clinic Martin Health’s Tradition Emergency and Saint Lucie West Emergency Department (Port St. Lucie, Fla.): We have a pretty robust EMS volume that comes to Tradition. To facilitate ease of care for those patients, we set up what we call our EMS arrival position: a triage nurse at the back door. During peak hours we have someone stationed at the back door to immediately greet EMS, get patients into the system and start their care. If a room is available, they go straight there. If not, they’re brought into the EMS bay, where triage begins right away — labs are drawn, care is started — so by the time a room opens up, they’re ready to be moved. We can position four or five patients in that area without losing an FTE. That triage nurse helps facilitate EMS arrivals, ensures patients are entered into the system, and most importantly, gets EMS providers back on the road so they’re not stuck waiting in the ambulance bay. It’s helped our EMS partners tremendously, and they’ve been very pleased with it.

Our ED also has dedicated pediatric rooms, staff and child-friendly spaces tailored for that population.

Since deploying these models, we’ve seen a drastic reduction in left without being seen and are now at 2.4%, well below the national average. We also saw double-digit improvements in patient perception of ease of access.

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