How RWJBarnabas Health Improved Emergency Department Efficiency

By Christopher Cheney

RWJBarnabas Health has scaled an emergency department efficiency initiative that has generated several positive outcomes including reduced patient wait times.

Emergency rooms are an essential patient front door for health systems and hospitals. When run efficiently, emergency rooms drive positive patient experience as well as staff satisfaction.

“We want our patients to have the best possible experience and best possible outcome when they are seen in our hospital emergency rooms,” says Andy Anderson, MD, MBA, executive vice president as well as chief medical and quality officer at RWJBarnabas. “Emergency room care is an important piece of how we are caring for our patients as a whole person, and the efficiency of care in the ER impacts how the patient feels and how the patient does from a clinical standpoint.”

Emergency department efficiency should be among the top concerns of a CMO. According to Anderson, a CMO should be an advocate to promote efficiency generally and specifically in the emergency rooms.

“A CMO should help remove any barriers as well as help communicate with physicians, nurses, and others about the importance of emergency room efficiency initiatives,” Anderson says. “A CMO should help navigate through approvals at the health system with regard to changes in policies and procedures.”

“Coming out of the coronavirus pandemic, we had tremendous wait times and inefficient processes,” says Christopher Freer, DO, senior vice president of emergency and hospitalist medicine at the health system. “We needed a reset of how we were looking at care. Once we got out of disaster mode, we focused on many things that we could control such as how we handled the arrival of a patient.”

In addition to improving the patient experience in emergency rooms, RWJBarnabas sought to improve efficiency in the emergency department to improve staff experience and well-being.

“Emergency departments are a top setting for burnout among physicians and nurses,” Freer says. “Working in an inefficient environment can be taxing on the staff.”

How RWJBarnabas improved ER efficiency

There were four primary elements in RWJBarnabas’ emergency department efficiency initiative, which began at Cooperman Barnabas Medical Center.

First, the health system adopted direct bedding for patients as soon as possible after patients arrived at emergency rooms.

“Direct bedding means as soon as the patient walks into the entrance to the emergency department or arrives via ambulance, if we have open beds the patient is moved to a bed as soon as possible,” Freer says. “Then staff members including doctors, nurses, and technicians go to the patient.”

Direct bedding can be difficult to execute, according to Freer. It takes a cultural shift, and staff buy-in is essential to changing workflows.

“You need to explain the ‘why’ of why it is good for the patient and good for the staff,” Freer says. “Once you get staff engagement, that is when direct bedding gets clicking, and you start seeing results.”

Second, RWJBarnabas streamlined the triage of patients in emergency rooms by applying simple concepts, according to Freer.

“When a patient comes into the emergency room, you take as little information as possible to make the decision to directly bed the patient,” Freer says. “You want to connect the patient to the provider and the nursing team as quickly as possible.”

Once basic information has been collected, registration and completion of triage can happen after the care is initiated, Freer explains.

“Basically, we looked at how to safely and efficiently move patients into the emergency department quickly, which was critical,” Freer says.

The health system also made a staffing change to improve ER triage efficiency by assigning some of the most experienced ER nurses to triaging duty.

Third, RWJBarnabas harnessed real-time data to support the emergency department efficiency initiative.

“When we started this efficiency initiative, we had just finished adopting Epic as our health system’s electronic health record,” Freer says. “We leaned into Epic and enhanced it to make sure we were as efficient as possible.”

“The data we generate is timed from the time a patient walks in the door, a patient is triaged, a patient is seen by a doctor or physician assistant, and when a medication is administered,” Freer says. “We are metric-driven, and we share metrics transparently across all 12 of our emergency departments, which creates a competitive spirit.”

Fourth, RWJBarnabas initiated electronic handoffs to improve communication between staff members, including communication between physicians and nurses.

The electronic handoffs have helped to improve the efficiency of admitting patients to the health system’s hospitals, according to Freer. Now, there is standardization for a summary of what is going on with a patient for the nurses and for medications.

“There is a standard approach for the doctors, and a timeline for when they need to respond to each other after a patient has been admitted,” Freer says. “Transport, housekeeping, and other ancillary services are automatically triggered from the admission order. We make sure patients can get upstairs in a timely manner.”

Christopher Cheney is the CMO editor at HealthLeaders.