Long emergency department wait times frustrate not only the patients, but hospital staff as well. Let’s face it, emergency departments at hospitals haven’t been known to be pleasant experiences. After all, the reasons people go to one are extraordinary, and they expect immediate medical attention.
EDs have long had a bad rap due to the extreme length of time people have had to wait to be seen once they step foot through the door.
In the past, an ED has not been viewed as conducive to someone in crisis. It’s usually a place that’s chaotic, with many different types of emergencies commingled until each one is evaluated and admitted or discharged.
Cooperman Barnabas Medical Center in Livingston, part of RWJBarnabas Health, has changed all that. By dramatically improving its processes throughout its emergency department and the hospital, not only has CBMC dispelled bad experiences for ED patients, it has resulted in better efficiencies overall.
While the ED at CBMC was recently expanded, the medical staff at CBMC also worked very hard to make sure each patient receives the care they need in the most efficient manner possible.
CBMC has successfully been reducing emergency department wait times with its innovative way it thinks about getting patients through.
The ED began streamlining the patient process during COVID, as responding to patients during the pandemic required disaster care treatment.
“Since 2020, we were responding to the pandemic and all that it involved. Today, we are back to emergency medicine,” Maria Aponte, administrative director of the CBMC Emergency Department, said.
Aponte said the triage system that CBMC uses helps the medical staff get patients to an appropriate area for their specific needs within minutes of their arrival to the ED.
“You’re met by a triage nurse who will ask for the reason of your visit along with five quick demographic questions so we can get them entered into our electronic health record, and then a tech brings them directly to the bed,” she said.
Appropriate testing is then done, and, while the patient waits for test results, insurance information is collected.
The time a patient spends from registration to getting into a room at CBMC is about four minutes. The door-to-provider time is also in single digits (under nine minutes). So, when you put those two together, the door to provider time on average is under 30 minutes. And this is being achieved 91% of the time.
What makes CBMC’s ED so successful? Dr. Eric Handler, chairman of emergency medicine at CBMC, said it can only happen when all the departments work together. Handler said the model is so efficient due to interdepartmental collaboration between nursing, radiology, logistics, respiratory, environmental services, transport, the lab and complete support at the senior management level, including the CEO and president, chief operating officer and chief medical officer.
“The model for disaster medicine is very different from emergency medicine. With a focus on the patient being the center of the team, we have changed our care model, resulting in a much better experience for our patients as well as our staff,” Handler said.
While the expanded and renovated emergency department provides an enhanced environment to receive care, accommodating up to 130,000 adult and pediatric patients annually, it is the interdisciplinary approach that has made this successful.
“Our goal with our newly renovated emergency department was not only to increase space, but also to make the flow of treatment much easier so that patients are seen in a timely manner in an area appropriate to their needs,” he said.
Cooperman Barnabas Medical Center’s 25,000-square-foot emergency department has 101 beds available for utilization, a 53% increase from its previous capacity, with efficient bed turnover happening three or four times a day. Of those beds, there’s a Rapid Diagnostic Unit with approximately 26 beds. These patients are monitored for further evaluation before being officially admitted or discharged. Patients may stay up to 24 hours and receive extensive testing during the stay.
The median turnaround time for patients to be seen, treated and discharged was only 160 minutes.
Additionally, in recent weeks, the “leave without being seen” rate has been noted at about 0.01%. The hospital’s goal is under 1%, and the national threshold is more than 2%, so this is a great number.