Improving Patient Flow and Reducing Emergency Department Crowding: A Guide for Hospitals

Appendix B: Implementation Plan Template

Improvement Strategy Name: ___________________________________________________________


1. Goals and Strategies

Problem Statement
Goal Statement
Strategy Description

2. Approach

Project Team Members
Role Name Title Department
Barriers to Successful Implementation (actual or potential)
Method of Study Improvement (check one or more)
Plan, Do, Study, Act  
Implementation Steps
Activity (e.g., data collection, staff training,
development of new forms, purchases)
Who is responsible? Due Date
Communications Strategy
Who needs to know about the strategy? What information do they need? When do they need the information? Who will provide the information?

3. Estimated Time and Expenses

Estimated Number of Hours for Implementation
Role Name Number of hours per week Number of weeks Total number of hours
Resources Needed for Implementation
Resource Estimated expenditure ($)
Approvals Needed
Name Issue for Approval Date Approval
Date Approval


4. Performance Measures

Performance Measures (check all that apply)
ED Arrival to ED Departure – Admitted Patients  
ED Arrival to ED Departure – Discharged Patients  
Admit Decision Time to ED Departure  
Left Without Being Seen  
ED Arrival to Bed  
ED Arrival to Physician  
Other Measure:  
Other Measure:  
Other Measure:  

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Page last reviewed October 2014
Internet Citation: Appendix B: Implementation Plan Template. October 2014. Agency for Healthcare Research and Quality, Rockville, MD.