RWJBarnabas Health Maintains Momentum of Emergency Department Efficiency Initiative
By Christopher Cheney
After launching an emergency department efficiency initiative in 2023, RWJBarnabas Health continues to reap gains from the effort and is making sure all 12 of the health system’s EDs are sticking to the program.
Emergency rooms are indispensable patient front doors for health systems and hospitals, and efficiency improves patient and staff experience. RWJBarnabas Health saw a need to improve ED efficiency after the coronavirus pandemic and started by implementing new processes at Cooperman Barnabas Medical Center.
The ED efficiency initiative has four primary elements:
- Direct bedding: As soon as patients walk into an ED or arrive via ambulance, they are placed in an ED bed as soon as possible.
- Streamlined triage: When a patient arrives at an ED, only essential information is gathered from the patient to make the decision to directly bed the patient. Once basic information has been collected, registration and completion of triage occur after care is initiated.
- Harnessing data: The health system has leveraged its EHR to collect data on key ED metrics, including left without being seen, arrival to room, and arrival to seeing a provider.
- Improved communication: Electronic handoffs were created 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, with standardization for a summary of what is going on with a patient such as medications.
The ED efficiency initiative has improved performance on left without being seen, arrival to room time, arrival to seeing a provider time, and patient experience. It has also generated benefits for ED staff.
“One of the top contributors to burnout for physicians and nurses in the emergency department is not being able to deliver the level of care that they want to deliver,” says Christopher Freer, DO, EVP and chief clinical officer of acute care providers at RWJBarnabas Health. “The ED efficiency initiative has helped to improve patient care, which has improved the environment and has improved the burnout rate for our doctors and nurses.”
The initiative has also improved retention of ED physicians and nurses.
“In retention, we are outperforming our peers across the country,” Freer says.
The initiative has helped lessen the strain on the health system’s EDs during the ongoing respiratory illness season.
“We would have been in a world of hurt during the respiratory illness season for our staff and patients if we had not improved ED efficiency,” Freer says. “With the new processes in place, our EDs have been able to function efficiently and to handle the surge in respiratory illness cases over the past couple of months.”
Maintaining the momentum
The ED efficiency initiative has become “hard-wired,” according to Cathlyn Robinson, RN, MSN, vice president of emergency nursing operations at RWJBarnabas Health.
“We have 12 EDs in the health system, and every ED functions with the four elements of the efficiency initiative,” Robinson says.
RWJBarnabas has made intentional efforts to maintain the initiative’s momentum by sending teams to each ED site to remind them that the initiative’s elements are not optional.
“We also show a lot of data about how the ED efficiency initiative is working,” Freer says. “People are competitive. They don’t want to have the longest arrival-to-room time or the longest arrival-to-provider time.”
If there are deviations from the initiative, leaders work with EDs to make sure they are following the efficiency roadmap.
“We had one site that was not following every element of the ED efficiency initiative, and we did a site visit at that ED,” Robinson says. “We talked transparently as a leadership team about the opportunities we were seeing to improve efficiency. The leadership team at the site saw that they could improve, and they embraced the opportunity.”
Christopher Cheney is the CMO editor at HealthLeaders.