West Orange, N.J.-based RWJBarnabas Health is on track to see approximately 850,000 emergency visits this year. Despite this 5% annual growth, the system has managed to reduce ED wait times.
RWJBarnabas averages about 20 minutes from a patient’s arrival to first visit with a physician. At Cooperman Barnabas Medical Center in Livingston, N.J., home to one of the busiest EDs in the country, the median wait time is 10 minutes.
ED wait times are worsening across the U.S., according to research published in June. In the last three years, more than 25% of patients who visited an ED during a non-peak month waited four hours or more for a bed. During winter, that figure rose to 35%.
Waiting 24 hours or longer for a bed used to be rare, but by 2024, nearly 5% of all patients admitted to the hospital during peak months waited 24 hours for a bed, the same study found.
In 2022, RWJBarnabas Health was averaging 26 minutes from a patient’s arrival to their seeing a physician. The system was also averaging a 2.41% left without being seen (LWBS) rate and a median 8.5-hour length of stay (LOS) for admitted ED patients.
“We came limping out of COVID with really horrendous wait times, and we had to reset out of disaster mode,” said Christopher Freer, DO, senior vice president of emergency and hospitalist medicine of RWJBarnabas.
By mid-2025, the system has reduced its arrival-to-first-provider metric to 17 minutes, LWBS to 0.57% and LOS to 6.8 hours. Since 2023, the 14-hospital system has averaged a 20-minute ED wait time.
How RWJBarnabas did it
The system says it operates five of the 61 busiest EDs in the nation. To improve wait times, LWBS rate, patient experience and staff morale, RWJBarnabas leadership focused on transparent data and relentless checks on progress.
Between the end of 2022 and the start of 2023, leaders focused on building a patient-centered culture — particularly at the front door, according to Dr. Freer and Jennifer O’Neill, DNP, senior vice president of clinical operations of RWJBarnabas’ northern region.
Rather than an ED visitor registering, sitting in the waiting room, being triaged, and then sitting down again, RWJBarnabas moves everyone immediately.
“That’s not magical, right? Every emergency department can do that,” Dr. Freer said, adding that the “game changer” was the electronic handoff.
Before, an inpatient nurse could say, “I’m not ready for report,” or “I don’t want the patient in this bed. I want the patient to go in that bed, but the other patient hasn’t left yet,” Dr. O’Neill said. Or, a clinician might delay an inpatient bed placement during a shift change.
Overall, there were too many variables.
A throughput standard was present in 2022, but it wasn’t being adhered to. On Jan. 4, 2023, Cooperman Barnabas Medical Center formally implemented a plan. In February 2024, a playbook was shared across the system, and in March, the process was automated.
Now, ED workers can send a standardized admission Epic chat to hospitalists who are expected to respond within five minutes, according to Dr. Freer.
The logistics team, which he said has “an eye in the sky,” also communicates with physicians if an issue arises.
When a physician decides a patient needs an inpatient bed, that admission order is automated in the Epic EHR to alert the system’s logistics team. Dr. O’Neill, who also serves as COO of Cooperman, said that after the right bed is secured, the patient is placed there within 45 minutes.
“For any ED leader, nurse, physician — that’s gold,” Dr. Freer said.
In 2022, LOS for an admitted patient in Cooperman’s ED was about 12.5 hours. It is now 4.5 hours, he said.
Tips for replication
To achieve lower wait times, Dr. Freer recommended utilizing transparent data to set goals and hold people accountable. RWJBarnabas CNOs, COOs, physician leaders and other stakeholders receive a daily email on each site’s progress.
If a facility is consistently underperforming, the system sends a “little SWAT team” to work with the local leaders to achieve buy-in, he said.
Although RWJBarnabas has logged measurable success, the work is never done, Dr. O’Neill said.
“We’re three years in,” she said. “I think we have a standard workflow here, but we’re still […] an organization that’s looking at continuous process improvement. So even though we think we’re good, can we get even better?”
