Date of Award

Spring 4-6-2023

Document Type

Scholarly Project

Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

David Liguori, DNP, NP-C, ACHPN

Second Advisor

Lisa Chambers, DNP, NPD-BC, RN


Practice Problem: Crowding of emergency departments contribute to higher-than-average left without being seen (LWBS) rates. LWBS patients pose risks to the hospital as well as to one’s own health.

PICOT: The PICOT question that guided this project was in a pediatric emergency department (P), does implementation of a “Code Lobby Surge” (I), compared to standard care (C), decrease left without being seen rates (O) within eight weeks (T)?

Evidence: Surge interventions and decreasing the visual of crowding have shown to decrease LWBS rates.

Intervention: “Code Lobby Surge” was implemented to decrease LWBS rates and improve throughput within the pediatric emergency department. “Code Lobby Surge” is activated when the wait time for triage is over 30 minutes and the total number of patients pending triage exceeds 10 patients.

Outcome: The intervention decreased LWBS rates by approximately four percent.

Conclusion: “Code Lobby Surge” not only decreased LWBS rates, but also improved throughput of the emergency department. “Cody Lobby Surge” is an effective intervention to mitigate emergency department surges that contribute to LWBS rates.


Scholarly project submitted to the University of St. Augustine for Health Sciences in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice.

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This work is licensed under a Creative Commons Attribution 4.0 License.