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Saint Barnabas Medical Center

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Saint Barnabas Medical Center

Saint Barnabas Medical CenterEMA has been managing the emergency department (ED) physicians at Saint Barnabas Medical Center in Livingston, N.J., for more than 35 years. In that time, as the flagship facility of the Barnabas Health system, the medical center’s physical footprint and professional reputation has grown exponentially. The medical center treats more than 90,000 patients in its ED each year.

Recently, the emergency department began experiencing challenges getting admitted patients from the ED and onto inpatient units quickly. Once the physician placed the decision to admit order into the electronic medical record, it could take up to three hours for a patient to be transferred to an inpatient bed.

“The doctors would place an order for decision to admit, and then we’d wait for Bed Management to assign a bed. Once we received a bed assignment, we would then make attempts to call report to the receiving unit, place a request for transport, and maybe another 30 minutes would go by before the patient would  leave the ED,” explained Doreen Dutchak, administrative director of the emergency department. “We had our challenges getting patients out of the ED.”

To decrease the time it took to get a patient transferred to an inpatient unit, a well-timed electronic medical record upgrade gave the ED team additional tools needed to re-engineer the admission process. Christopher Freer, DO, medical director of the emergency department at Saint Barnabas Medical Center, collaborated with the departments involved in the transfer process including, hospital administration, nursing, transport, bed management, housekeeping and others to find ways to improve throughput.

“We knew our processes had to change for us to continue to provide timely care in the ED,” explained Dr. Freer. “It would be a challenge, but with input from all of the departments involved in the admission process, we were confident we could find a more efficient way to move patients safely through the ED.”

By using the EMR to request beds, transport, and other admission functions, the team eliminated the flurry of calls that usually accompanied an admission order. This, along with a collaboration between numerous departments, decreased the decision-to-bed time from 2.5 hours to about 45 minutes. (The national average for similarly sized EDs is 153 minutes, according to the Emergency Department Benchmarking Alliance.) Nurses from all of the medical center’s inpatient units can access each incoming patient’s summary from the ED record. An all-inclusive ED Summary was developed for the inpatient nurses. Now, they have all of the information needed to begin preparing for that patient’s arrival, creating a seamless, safe transfer of care and increasing patient satisfaction. Information regarding high-risk situations, such as combative patients, those at high risk for falls, suicidal patients or patients being restrained, continues to be given verbally. Patients admitted to critical care units are handed off via bedside report to ensure thorough and complete transition of care.

Now, the medical center’s left without being seen rate (LWB) has dropped to just .5% (the national average is 3.5%), while its door-to-doctor time has decreased to about 13 minutes (the national average is 42 minutes).

“We can care for more patients now, since we’re freeing up ED beds more quickly,” said Dutchak. “We’ve received great feedback about this improved process. Residents at local assisted-living facilities where Dr. Freer frequently speaks can’t believe how much quicker the admission process is. Physician satisfaction has improved as well.”

During the beginning stages of the initiative, the ED team met with nurse managers three times a week to share ideas and iron out any concerns. Those meetings have decreased to just once a week and focus more on ways to improve clinical care and outcomes.

Dutchak said that the initiative has been a success because the team had support from throughout the organization, including John F. Bonamo, MD, MS, president and CEO of Saint Barnabas Medical Center. The next project on the team’s agenda is improving its door-to-disposition time for treated and released patients.

“Everyone is committed to the process,” Dutchak said. “We’ll continue to evaluate how we do things and find ways to do them better.”

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