'Almost unheard of': New Jersey hospital shrinks 'left without being seen' rate to nearly zero

At Cooperman Barnabas Medical Center in Livingston, N.J., key emergency department statistics including "left without being seen" and "average time to see a physician" are at record lows, said Maria Aponte, BSN, RN, administrative director of emergency services at the hospital. 

This week, when Ms. Aponte and Eric Handler, DO, chair of Cooperman Barnabas' emergency medicine department, spoke with Becker's, the ED's LWBS average at Cooperman Barnabas is almost zero, 0.13 percent, and patients' time to see a physician in the ED is just under eight minutes — 7.7 minutes to be exact, she said.

"I can tell you from practicing emergency medicine for over 20 years that any wait under 10 minutes is almost unheard of," Dr. Handler said, noting the reduction in wait time and resulting patient satisfaction is due to a shift in strategy. 

Ms. Aponte said they decided to focus on emergency medicine instead of the "disaster medicine" all hospitals have been practicing during the COVID-19 pandemic.

"We've been doing disaster medicine, and emergency physicians and our entire emergency department is also prepared for disasters. In fact, we've been preparing for disasters since 9/11," she said, "So when the pandemic hit, we went into disaster mode. Now we are returning back to emergency medicine, and this is what efficient emergency medicine should look like." 

Dr. Handler and Ms. Aponte put in place a direct bedding initiative to eliminate the need for an ED waiting room and reduce patient waiting times and also encourage the cooperation from every service line that interacts with the ED. 

When all departments are working together to expedite services, patients are able to move through the system more efficiently. They are met by a greeter nurse upon arrival at the ED and are immediately taken back to a bay where they are triaged, seen by clinicians and are ultimately discharged with instructions or admitted to the hospital expeditiously.

Of course, Ms. Aponte pointed out, anyone who presents with a life-threatening situation — stroke or myocardial infarction, as examples — gets prioritized.

"Our boats are filled and everybody's rowing in the same direction. It requires all different parts of the team in the emergency department and other services — radiology, logistics, respiratory, environmental services, transport, the lab — to work closely together," Dr. Handler said. "It also requires ED leadership and the hospital's senior management team to be aligned to make sure that admitted patients are transferred to an inpatient bed/room as quickly as possible. It's a tight partnership."

To keep the "boat" sailing smoothly, Ms. Aponte said, leadership from each of the departments involved with emergency care meets often to review the cooperative action plan and make improvements when needed. Additionally, she said, support for this initiative comes from the top; Cooperman Barnabas' senior leadership — CEO, COO, chief nursing officer and chief medical officer — is supportive of this cooperative process and participates in these meetings so there is no question about the ultimate directives and goals.

When all service lines are in sync, Dr. Handler said, there is a place for every patient in the ED thanks to a newly constructed 25,000-square-foot emergency department that opened in 2022. The expansion increased capacity by 53 percent. Bed count went from 66 to 101 in the main ED bays, plus 10 pediatric beds and 12 beds in a fast-track area. Additionally, the hospital's observation unit has 22 beds.  

"Prior to the expansion, we were seeing 100,000 patients a year in an emergency department built to handle 66,000 patients. Now, our emergency department has the capacity to handle an annual volume of 130,000 patients," Dr. Handler said.

Ultimately, Dr. Handler said, the success of Cooperman Barnabas' direct bedding initiative comes down to holding people accountable to do their jobs well and efficiently.

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