Case studies

TidalHealth Peninsula Regional


TidalHealth Peninsula Regional in Salisbury, Maryland, is the oldest healthcare institution on the Delmarva Peninsula, providing care to residents for over 120 years. Today, TidalHealth remains the region’s largest tertiary care facility with 266 beds, approximately 3,300 physicians, staff, and volunteers, and a local economic impact of over $500 million. TidalHealth annually provides care to nearly 500,000 patients, with over 78,000 inpatient days per year.


  • Healthcare


  • Spok Go® secure messaging and on-call scheduling

Business drivers

  • Improve ED patient admissions process
  • Streamline patient transfers
  • Decrease ED crowding, treatment delays, and ambulance diversions


  • 44-minute reduction in boarding time (time of admit decision to time the patient transfers to a bed)
  • 31-minute reduction in ED length of stay
  • 79% increase in hospitalist satisfaction with the overall admission process
  • Streamlined communication among emergency medicine providers, admissions case coordinators (nurses), and admitting hospitalists

The challenge

The ED is a high-risk, high-stress environment that’s often considered the most operationally complex clinical setting in the hospital.

As a Level 3 Trauma Center, TidalHealth Peninsula Regional was averaging over 90,000 ED visits per year and 15,000 ED admissions (2019). The average time from a patient’s ED arrival to their placement in a hospital bed was 340 minutes.

Continually improving ED throughput has been a top priority at TidalHealth Peninsula Regional given the increased rates of ED use. However, like most hospitals and health systems, the organization struggled to implement the tools to facilitate the efficient ED provider to hospitalist collaboration that would produce meaningful change. Not only did this communication breakdown impact patient flow, but it also caused poor provider satisfaction with the ED admissions process.

Keeping the lines of communication open

The causes of ED delays, overcrowding, and low throughput are complex. Research has shown that 80% of serious medical errors involve miscommunication among medical providers at the point of patient hand-off. Hospitalists, emergency medicine providers, and nurses often struggle to keep the lines of communication open. The back-and-forth communication that takes place when coordinating inpatient requests from the ED often creates confusion and delays.

“Even before the COVID-19 pandemic, we were experiencing increasing patient volumes,” said Glenn Hornstein, MD, ED Director at TidalHealth Peninsula Regional. “We needed to take actionable steps to improve ED wait times and throughput.” At the height of the pandemic, TidalHealth Peninsula Regional was admitting, on average, 30 patients per day and discharging about four or five per day.

The solution

Given provider and nursing shortages, available resources are limited. Dr. Hornstein and his team determined that a technology-driven, system-wide approach would be most successful for improving emergency care. “The ED doesn’t operate in isolation,” he explained. “If we were going to substantially improve quality patient outcomes and reduce costs, this would have to be more than just an emergency department initiative.”

When Christopher Snyder, DO, chief quality officer and hospitalist at TidalHealth Regional Peninsula, heard that the ED wanted to improve throughput, he suggested the team consider how Spok Go technology could help streamline providers’ communication. A longtime Spok customer for paging and contact center solutions, TidalHealth Peninsula Regional had been one of the first organizations to implement Spok Go.

“Other areas of the hospital were implementing Spok Go to collaborate and communicate more efficiently,” Snyder said. “Given the results we were seeing in other departments, I knew Spok Go could help facilitate better collaboration between the ED and inpatient areas.”

Using Spok Go secure messaging, the entire care team gained a self-service tool to make it easy to reach the correct provider and share important patient information (such as vital signs) — directly from their personal mobile devices.

Additionally, Spok Go automatically incorporates directory information and on-call schedules to streamline workflows. By adding the TidalHealth Peninsula Regional monthly on-call schedule into the Spok Go system, anyone on the care team could quickly message the correct on-call provider.

Spok Go facilitates communication and resource collaboration.

– Glenn Hornstein, MD, Director, Emergency Department

The result

“With Spok Go we were able to introduce technology into old-school processes and dramatically improve some of the disorganized patient transfer processes,” Snyder said.

Melissa Martin, BSN, RN-ACM, admissions case coordinator, agrees. “Everyone wants our patients to move through the hospital smoothly and ensure the right care is delivered in the right place,” she said. “To do this, we need to engage the right resources at the right time.”

In fact, The Joint Commission standard LD.04.03.11 requires hospitals to develop processes to support patient flow and recommends boarding times be limited to four hours.2 “Every hospital in the country is trying to improve ED throughput,” Snyder said. “I think other hospitals want a tool like Spok Go. It’s a quick, visible tool that helps improve the ED admissions process and reduce length of stay.”

Using a collaborative, technology-driven approach, TidalHealth Peninsula Regional has achieved substantial improvements in patient flow, including:

TidalHealth plans to further improve throughput by expanding the use of Spok Go for other specialties.

The organization also saw a statistically significant improvement in overall satisfaction with the admission process. ED providers, admissions case coordinators, and hospitalists rated the process improvement as follows: