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About this IHI Virtual Expedition

​​Over the years the demand for hospital Emergency Department (ED) services has steadily increased, while capacity in most hospitals is severely strained. EDs are often plagued with long waits and overcrowding, often leading to poorer care, increased costs, and frustration for both patients and staff.

This Institute for Healthcare Improvement (IHI) Virtual Expedition will help teams create more efficient care processes in the ED through the understanding and application of lean principles, constraint management and quality improvement methodologies – all of which have been shown to dramatically improve ED outcomes and experiences for patients and staff. 

What You'll Learn

At the end of this Expedition, each participant will be able to:

  • Describe key operational principles for a high functioning ED
  • Implement improvement strategies and techniques in their own organizations
  • Identify how specific patient segmentation considerations can positively impact wait times and length of stay
  • Identify three key techniques to decrease boarding and manage surge capacity
  • Describe successful strategies for improving flow with emergency psychiatric patients 
This IHI Virtual Expedition is approved for a maximum of 6.5 continuing education credits for nurses, physicians, and pharmacists.​


Session 1: Strategies for Perfecting ED Operations
Date: Wednesday, October 25, 2017, 12:00 PM–1:30 PM ET

Session 2: A Wait-less Waiting Room - Kaiser Permanente Sacramento Case Study, Part 1
Date: Wednesday, November 8, 2017, 12:00 PM–1:00 PM ET

Session 3: A Wait-less Waiting Room - Kaiser Permanente Sacramento Case Study, Part 2
Date: Wednesday, November 22, 2017, 12:00 PM–1:00 PM ET

Session 4: Improving ED Throughput with Complex Patients
Date: Wednesday, November 29, 2017, 12:00 PM–1:00 PM ET

Session 5: Triaging and Placement of ED Patients with Behavioral Health Conditions
Date: Wednesday, December 6, 2017, 12:00 PM–1:00 PM ET

Session 6: Various Options for Observation Status Patients
Date: Wednesday, December 20, 2017, 12:00 PM–1:00 PM ET


John_T_Crane.jpgJohn T. Crane, MD, MBA, is an Emergency Physician at Mary Washington Hospital, and also serves as the Business Director of Fredericksburg Emergency Medical Alliance. As an Adjunct Professor for the Physician Executive MBA Program at the University of Tennessee, he teaches physician-led operations improvement. His work focuses on innovative approaches to ED and hospital-wide operational and patient flow improvement, specifically addressing the application of lean manufacturing concepts within the health care environment. Dr. Crane also teaches Lean Health Care courses for The University of Tennessee Center for Executive Education. He has been a faculty member for the IHI's Learning and Innovation Community on Operational and Clinical Improvement in the Emergency Department.

Kathy_Duncan.jpgKathy Duncan, RN is a Director at the IHI. She's served as faculty for the Hospital Engagement Network Improvement Leadership Fellowship of the American Heart Association's Health Research and Educational Trust. Ms. Duncan also directed content development and spread expertise for IHI’s Project JOINTS (Joining Organizations IN Tackling SSIs), an initiative funded by the federal government. In 10 US states, Project JOINTS spread three evidence-based pre- and perioperative practices to reduce the risk of surgical site infections in patients undergoing total hip or knee replacement. Previously, Ms. Duncan co-led the 5 Million Lives campaign national field team. Prior to joining IHI, Ms. Duncan served as Director of Critical Care for a large community hospital.

frankfedericoa.jpgKaren Murrell, MD, MBA is Assistant Physician in Chief for Process Improvement and Optimization, Kaiser South Sacramento, and Chief of Emergency Medicine at Kaiser Permanente Medical Center. She has more than 30 years of experience in a variety of roles in hospital and emergency department management and practice. At Kaiser Permanente, Dr. Murrell has focused on taking innovative approaches to patient flow in both the emergency department and the inpatient hospital, using Lean methodology to improve departmental flow. The result has been markedly decreased rates of time to physician and length of stay, as well as decreased “left without being seen" rates. Dr. Murrell is a leader on the Hospital Throughput Committee, which is using queueing methodology to improve patients' length of stay and reliably predict staffing needs. She is a frequent presenter on her work and the co-author of a paper on flow.