The hospital waiting room was nearly empty.
No desperate patients waiting to be seen. No harried medical workers scurrying to keep up.
But the recent calm in the Cooperman Barnabas Medical Center emergency department had nothing to do with a dearth of the sick and injured, hospital staff say. In fact, more than 300 patients had sought treatment on May 8 alone.
Instead, the medical center thinks it’s all but eliminated wait times.
Cooperman Barnabas has slashed the wait to see an emergency department physician to less than eight minutes, officials say — an almost unheard of achievement, according to experts. It’s part of a new strategy rolled out in January, making last week’s tranquility the new normal at the Livingston hospital, its staff says.
“Our goals are empty waiting rooms,” said Dr. Christopher Freer, senior vice president of emergency and hospitalist medicine at RWJBarnabas Health, Cooperman Barnabas’ parent health system. “If people are waiting in the waiting room or leaving before we see them, we feel like we’re failing our communities.”
Dr. Alexander Janke, an emergency department operations expert and emergency medicine physician at Hurley Medical Center in Flint, Michigan, says few hospitals can boast such a benchmark.
“Ten-minute wait times — that’s an aspirational goal. If they can achieve it, that’s incredible,” said Janke, who has studied the ongoing problems in American emergency rooms.
The innovation partially rose out of the hard-earned lessons from the COVID-19 pandemic. The medical staff witnessed the suffering and tension of a crowded waiting area and how it strained the department’s operations and staff.
So Cooperman Barnabas flipped the intake process on its head, officials say.
The old way, common to many hospitals, was to have patients sit in the waiting room, briefly triage them to determine the level of their emergency and collect their insurance and financial information. Then they would wait for a doctor.
The mean wait time in U.S. emergency departments with 50,000 or more annual visits like Cooperman Barnabas? Almost 49 minutes, according to a 2019 Centers for Disease Control and Prevention fact sheet — although that was before the pandemic.
In New Jersey, the average wait time for admitted patients is now 173 minutes, one of the longest in the nation, according to an annual report by Autoinsurance.org.
But since January, Cooperman Barnabas patients check in and are ushered into a room where a physician or advanced practice provider examines them and begins initiating tests if necessary. Insurance and financial information is collected bedside, in the downtime.
Meanwhile, the hospital has streamlined operations in other departments, it says, knowing that delays in processing lab results or conducting an X-ray can also clog up the ER for hours.
The new strategy — a combination of the “direct bedding” concept, getting a patient immediately into a room, and enhanced coordination — has cut the average time to see a physician to just 7.7 minutes, hospital officials say.
“You walk in the front door, you get seen by the greeter nurse: ‘What can we help you with today?’” said Dr. Eric Handler, chair of Cooperman Barnabas’ emergency medicine department. A patient then provides basic information for the electronic health record, “and we move you directly to a bed.”
The new initiative has also reduced the number of patients who leave without being seen — walking out in exasperation because they were tired of waiting — to practically zero, they say.
A new and larger emergency department, now spanning 25,000-square-feet and 101 beds in the main bays — up from 66 — has helped. That doesn’t include 10 pediatric beds and 12 beds in a fast-track area. The expansion was completed last year.
But direct bedding has been key, hospital leaders say.
Freer recalls a seminal moment years ago. A patient said, “I wish when I came to the hospital, they asked me how I’m feeling and not for my insurance and registration.”
The realization dawned that the hospital was prioritizing finances, not care. And every minute that passed only heightened the anxiety of a trip to the ER.
Officials also focused on the downtime in the process, whether waiting for an MRI machine to become available or for blood tests to be processed, and saw plenty of other opportunities to handle paperwork such as insurance.
“So we don’t do any of that upfront,” Freer said. “We start clinical care first, and then you can do those things later that need to be done to register the patient.”
Janke, the emergency department operations expert, applauded Cooperman Barnabas for making wait times a focus.
It can do wonders for patient experience, an increasingly important metric in health care, he said. It plays a critical role in determining how much a hospital is reimbursed for care by the federal government, and reviews help shape the facility’s reputation within the community.
But at times, there was a hint of caution in Janke’s voice. Maintaining such a benchmark as 7.7 minutes will be a challenge. Everything has to work in concert. Just one issue or one underperforming department can cause a cascade of slowdowns, creating a bottleneck.
Preventing delays necessitates constant coordination and “buy-in from the health system at large,” Janke said. And it means juggling high and low acuity patients, pediatric patients and those who can be cleared and discharged.
“I’m unaware of any place in the country that has done that well,” Janke said.
Freer is now coordinating with leaders throughout the 12-hospital RWJ Barnabas network to see how the strategy might work at other facilities.
Hospital leaders saw a need for change after the pandemic ushered in what they called disaster medicine. They also recognized the stress of a packed waiting area and delayed care.
“We were saying, ‘How can we efficiently and effectively get the patients seen right away?’” said Maria Aponte, a registered nurse and administrative director of emergency services. She and Handler have helped oversee the new strategy.
“We don’t want a patient to be not seen and have them walk out the door,” Handler said.
But every piece of the puzzle must work together.
“We need all of those folks working together in harmony,” Handler said.
Our journalism needs your support. Please subscribe today to NJ.com.
Spencer Kent may be reached at [email protected].
