Savannah Wilson

Abstract

Efficient diagnostic workflows are critical in emergency departments (EDs) to support timely clinical decision-making. This project aimed to reduce the order-to-collection time for urinalysis (UA) in a high-acuity suburban ED, with the broader goal of improving overall patient throughput and length of stay.

Baseline data showed that 52% of ED patients had a UA ordered, with a median order-to-collection time of 52 minutes. In March 2025, a multidisciplinary team led a Kaizen event to evaluate and improve the process. The resulting workflow focused on early identification of UA needs, clearer communication among staff, and better-defined roles for timely urine collection.

With 39% of the ED population aged 65 or older—and more than half of all patients requiring UA testing—early collection became a priority. For walk-in patients, urine samples were obtained prior to room placement. EMS patients who could ambulate were offloaded into wheelchairs to collect urine before being taken to their bed. For those waiting in the lobby, a designated sample bucket was checked every 30 minutes to ensure timely pickup.

To encourage staff engagement, a month-long competition was held in April 2025 to reward the fastest collectors. Prizes were awarded to the top five staff, with an additional incentive—a holiday off—given to the first-place performer. Weekly leaderboards were posted to sustain interest and momentum. The new process was communicated through handouts, education during morning huddles, and staff meetings to ensure alignment and consistency.

Following implementation, the median UA collection time decreased from 52 to 20 minutes, a 31% improvement. This also contributed to a 5% reduction in provider-to-disposition decision time, demonstrating a positive downstream effect on patient flow. Staff reported feeling more empowered and aware of the impact their timeliness had on patient care and outcomes.

The intervention was presented to a system-wide ED council to share the success with other hospitals in the network. Providers expressed satisfaction with being able to make clinical decisions more quickly. To maintain improvements, collection time updates are now shared in daily huddles, ensuring ongoing accountability and awareness.

This initiative highlights how even routine clinical processes—when redesigned with collaboration and accountability—can significantly improve patient care efficiency in a high-volume ED environment.

Takeaways:

1. Operational changes can drive clinical impact: Attendees will understand how targeted process improvements, even for routine tasks like urinalysis collection, can significantly reduce delays and improve patient flow in the ED.

2. Frontline engagement is critical: The project demonstrates how engaging staff through education, incentives, and ownership of metrics leads to sustained improvement and increased motivation.

3. Kaizen methodology can be applied to ED challenges: Viewers will learn how a structured, collaborative improvement model can be effectively used in fast-paced, high-acuity environments.

4. Early diagnostic planning reduces downstream delays: By rethinking when and how urine samples are collected, the ED achieved both faster lab turnaround and reduced time to provider decisions.

5. Simple changes create system-wide value: Attendees will see how small, low-cost interventions can be scaled and shared across hospital systems to improve consistency and care delivery.