The final interval within the emergency department (ED), the disposition-to-departure, presents special challenges with respect to improving flow. Although difficult to improve, it is one of the most important determinants of ED performance. Why is it so difficult? Because it involves fixing hospital-wide flow. It involves interacting in a meaningful way with staff and processes on the inpatient side and working together to improve flow throughout the hospital. It means challenging “the way we’ve always done it” and getting buy-in from the top down so that the hospital is vested in ED performance (Figure 13.1). The dispo-to-departure interval. https://s3-euw1-ap-pe-df-pch-content-public-u.s3.eu-west-1.amazonaws.com/9781315151915/f49314ad-c229-4e75-b42f-a008833ad4d8/content/fig13_1_B.tif"/>