To get a larger, more holistic view of the patient flow process, a multidisciplinary improvement team at Children's Hospital of Philadelphia (CHOP) developed a five-domain patient flow scorecard. Each domain has several weighted sub-metrics that add up to 20 points, so the maximum number of points in the composite score is 100. Improvement team leaders say the approach has helped them home in on specific reasons for hold-ups so that resources can be focused in the most effective way. The "ED and ED-to-inpatient transition" domain includes eight sub-metrics that cover five specific time intervals, the leave-without-being-seen (LWBS) rate, and two adjustment measures that are used to account for high volumes and high admission rates from the ED. The other domains cover bed management, the discharge process, room turnover and environmental services, and scheduling and utilization. Administrators say it is important to establish metrics that can be captured easily along with entry points that tie in with workflows.