According to the CDC, there were nearly 124 million emergency department visits in 2008, up from nearly 117 million visits in 2007. An aging population and an increase in uninsured and underinsured residents have resulted in a larger number of patients seeking treatment through the ER. This growing dependency on hospital ERs has a direct bearing on longer patient stays and overcrowding occurring in hospitals across the country.

MHA Keystone: ER aims to prevent harm to emergency patients by improving safety practices and attitudes, reducing boarding/overcrowding and wait times, and supporting the early treatment of sepsis using evidence-based best practices. These interventions ensure the most critically ill patients receive treatment first and reduce the likelihood that a patient will leave a hospital before being seen.

As a result of MHA Keystone: ER, participating hospitals have experienced a 29 percent decline in the rate of patients who left without being seen (LWBS). 

Nearly 200 participants attended the MHA Keystone: ER workshop in December 2010 to mark the completion of nine months of training in Lean practices and to recognize the improved culture of safety and the enhanced patient flow derived from the Lean methodology. Each participating hospital shared either a storyboard presentation or video testimonial to showcase the differences made through its participation in MHA Keystone: ER and the journey taken to generate these improvements.