Slow patient throughput doesn't have to be the norm in your ED. In this article, leaders from several hospitals discuss strategies they have used to improve patient flow, reduce patient wait times, decrease ambulance diversion hours, and improve resource use. Labor costs present a significant challenge to many emergency departments, and the experience at Huntsville Hospital in Huntsville, Ala., was no different. The 900-bed facility and Level 1 trauma center has an annual volume of 110,000. In 1995, the hospital was using an outsourcing group to provide physician coverage. For a flat subsidy of $100,000 a month, the group provided 70 hours of physician coverage per day (coverage was determined by the staffing group). Worse still than this high cost was that of 43 positions credentialed, only five were filled by physicians board certified in emergency medicine. "The result was a wide variety of practice patterns," explains Jeffrey Brown, administrative director of the Huntsville Hospital Systems Emergency Physicians Group. To improve ED labor costs and management, leadership took the following approach: Properly staff the medical director position. "You need someone who will be the medical face of your program, who will attend service line meetings, develop protocols for the department, and be willing to serve on different committees that interact with other departments that make the decisions that are going to affect the ED," explains Brown. Too often hospitals don't put enough emphasis on "face" time. Don't let revenue be the primary lure for recruitment. "Most physicians don't grow up hoping they'll move to Alabama. We're further hamstrung by the fact that at the time, there were no emergency residency programs in the state, and residents tend to stay pretty close to where they train." Yet throwing dollars at the situation didn't seem like the best option. Those motivated by money will be more likely to move on as soon as someone else presents a higher offer.