From Waiting to Welcoming: How Children’s of Alabama Elevated the Pediatric Emergency Department Experience
Improving patient experience in a pediatric emergency department (ED) is a complex challenge. High patient volumes, unpredictable demand, emotional stress for families, and operational constraints can quickly lead to long wait times, communication breakdowns, and dissatisfaction.
For Children’s of Alabama, these pressures were clearly reflected in patient experience data and demanded action. In partnership with NRC Health, Children’s of Alabama undertook a focused, interdisciplinary initiative to reimagine the pediatric ED experience.
By combining real-time patient feedback, proactive operational planning, and intentional environmental design, the organization delivered measurable improvements for patients, families, and employees alike.
Key Takeaways:
- Real-time patient feedback drives targeted change: Simplified NRC Health insights helped frontline teams act quickly on what mattered most, especially communication.
- Early surge activation reduces wait times and occurrences of Left Without Being Seen (LWBS): Proactive capacity management prevented bottlenecks before they escalated.
- Environment influences experience: Sensory-friendly spaces and normalization tools reduced anxiety for children and families.
- Interdisciplinary collaboration sustains results: Shared governance ensured that experience improvement was owned across roles, not siloed.
- Human-centered design improves both experience and performance: Experience gains aligned with operational efficiency, staff satisfaction, and revenue protection.
The result was not just improved scores, but a fundamental shift from a place of waiting to one of welcoming, earning Children’s of Alabama top performance rankings among peer pediatric emergency departments. Their successes were recently highlighted in a case study in partnership with The Beryl Institute.
Keep reading for additional insights.
The Challenge: Experience Scores and LWBS Above Target
Children’s of Alabama’s pediatric emergency department faced two significant challenges:
- Patient experience scores were below target
- Left Without Being Seen (LWBS) rates exceeded organizational goals
Elevated LWBS rates created clinical, financial, and safety concerns—particularly for vulnerable pediatric populations. Additionally, benchmark comparisons against peer pediatric hospitals revealed that improvement was necessary to remain competitive and aligned with best practices.
These challenges also had a human cost. Long waits, unclear communication, and overstimulating environments affected patient and family confidence, while high-pressure conditions contributed to staff fatigue and morale concerns.
The question was not simply how to move patients through the ED faster, but how to create a more welcoming, supportive, and effective experience without compromising care quality.
A Human-Centered Approach Grounded in Real-Time Insights
To address these challenges, Children’s of Alabama formed an interdisciplinary improvement committee that included:
- Physicians and nurse practitioners
- Registered nurses and clinical assistants
- Respiratory therapists and registration staff
- Volunteers, social workers, and chaplains
- Certified child-life specialists and patient relations leaders
In collaboration with NRC Health, the team intentionally simplified and reorganized patient experience feedback so frontline staff could more easily interpret and act on insights. Rather than relying on delayed or overly complex reports, the ED focused on real-time patient comments and survey responses, allowing teams to respond quickly and adjust interventions as needed.
Shared governance ensured that frontline voices were part of decision-making, reinforcing that experience improvement was not a top-down initiative, but a shared commitment.
Focus Areas for Improvement
1. Simplifying and Activating Experience Data
The team redesigned their NRC Health ED patient feedback form to focus on the most meaningful drivers of experience, particularly communication between providers, nurses, patients, and families. Real-time comments were reviewed alongside peer hospital insights and multidisciplinary team input to guide specific improvement actions.
This shift helped translate feedback into clear, actionable priorities rather than abstract scores.
2. Early Surge Activation to Improve Flow and Access
Operational readiness played a central role in reducing wait times and LWBS. The ED implemented:
- Demand-capacity charts to anticipate volume
- Earlier activation of surge spaces
- Clear guidelines for surge activation
- Pairing float nurses with providers for efficiency
- Close collaboration with hospital supervisors to optimize patient placement
Early activation helped decompress waiting areas sooner, reducing bottlenecks and maintaining patient flow during peak demand.
3. Designing an Environment That Supports Pediatric Needs
Recognizing that environment directly affects pediatric experience, Children’s of Alabama enhanced physical spaces to support comfort, coping, and confidence. Improvements included:
- Sensory-friendly waiting and triage spaces
- A dedicated sensory-inclusive triage room
- A book vending machine to normalize the experience
- Updated triage TVs to improve communication
- Renovations to the SANE exam room
These changes reduced anxiety for patients, especially those with sensory sensitivities, and helped families feel more supported from arrival through discharge.
4. Integrative and Supportive Care Enhancements
To further humanize the ED experience, the team introduced:
- A Care Cart stocked with hospitality and comfort items
- Meal vouchers for families facing long stays
- Expanded volunteer roles and streamlined orientation
- Increased access to interpreter services
Together, these enhancements addressed emotional, cultural, and practical needs—acknowledging that experience extends beyond clinical care alone.
5. Staffing Investments That Support Experience
Children’s of Alabama also made targeted staffing investments to sustain improvements, including:
- Increased RN FTEs to improve nurse-to-patient ratios
- Flexible shift options to support coverage
- Expansion of the ED with a dedicated behavioral health hallway
These efforts helped reduce staff strain while supporting consistent, high-quality interactions with patients and families.
Measurable Results
The combined impact of these efforts produced exceptional outcomes:
- Net Promoter Score (NPS) improved by 12.8%, reaching 78.1, compared to a peer average of 55.6
- Good Communication scores increased by 4.3 points, rising to 72 from 2023 to 2024
- LWBS rates dropped from 4% in 2023 to 1.7% in 2024, the lowest rate outside of the period around COVID
- The hospital was ranked #1 among 24 pediatric emergency departments that use NPS as a benchmark
- The hospital was awarded NRC Health’s Excellence in Patient Experience—Pediatrics Award for 2023–2024
Operationally, reduced LWBS improved throughput efficiency and minimized lost revenue from missed visits. Improved surge protocols and staffing alignment also helped reduce overtime costs while boosting staff satisfaction.
Lessons Learned: Experience Is an Ongoing Commitment
Through this work, Children’s of Alabama reinforced several key lessons:
- Early surge activation is critical to maintaining flow and reducing frustration
- Interdisciplinary collaboration strengthens decision-making and ownership
- Environment matters—especially in pediatric care, where sensory and emotional needs are heightened
- Real-time feedback enables continuous adaptation, not one-time fixes
Looking ahead, the ED plans to expand normalization resources, increase access to coping-supporting technology, and further integrate shared governance into ongoing NRC Health feedback review, ensuring that progress continues.
Advancing Human Understanding in Pediatric Emergency Care
This case study underscores what’s possible when healthcare organizations listen deeply, act intentionally, and design care around the people they serve.
By aligning real-time insights, operational readiness, and supportive environments, Children’s of Alabama transformed the pediatric ED from a place of waiting to one of welcoming.
