Date of Doctor of Nursing Practice Project Completion
Spring 2026
Faculty Advisor
Dr Francine Snow
Abstract
Purpose
The purpose of this quality improvement project was to evaluate the effectiveness of a standardized psychiatric transfer workflow designed to reduce emergency room (ER) boarding time for psychiatric patients in a 30-bed acute care hospital from an average of 3-5 days to an average of 2-3 days.
Background
Psychiatric patients often experience prolonged ER boarding while awaiting inpatient psychiatric placement. These delays contribute to delayed treatment, worsening psychiatric symptoms, ER overcrowding, and increased healthcare costs.
Methodology
This four-week quality improvement project utilized the Plan-Do-Study-Act (PDSA) framework. Interventions included a standardized psychiatric transfer protocol, simplified transfer checklist and staff education. Outcomes were measured through weekly chart audits, electronic timestamp verification, checklist compliance, timely Health Crisis Assessment Team (HCAT) evaluations, contract bed utilization, and a nine-question staff survey.
Results
Among patients with a completed checklist, 79% (19 of 24) were transferred or discharged within the project goal of two to three days.
- Checklist completion improved from 54% to 77%
- ER to SAHA transfer time decreased to 3.3 hours
- Contract bed utilization rose from 47% to 68%
- Average boarding decreased from 4.1 days to 2.4 days with checklist completion.
Implications
Standardizing the transfer process improved workflow and demonstrated the potential to reduce boarding. Ongoing staff education, leadership support, and improved coordination with transportation are essential to sustainability.
Keywords
emergency room, boarding patients, psychiatric patients, patient throughput, PDSA, quality improvement
Recommended Citation
Candice J. Battle, "Improving Throughput: A Quality Improvement Initiative to Expedite Inpatient Psychiatric Placement from the Emergency Room" (2026). Doctor of Nursing Practice Final Project Abstract. 223.
https://digitalcommons.library.tmc.edu/dnp_abstract/223