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NJ hospitals reduce ED waits, cut costs

Initiative focused on streamlining processes and procedures in both operating rooms and emergency departments

When 14 New Jersey hospitals took part in an initiative to improve overall efficiency in their operating rooms and emergency departments, they didn't expect to boost revenues and cut costs. But that's what happened.

The facilities discovered that they were also able to streamline patient flow, reduce ED wait times and shorten patient hospital stays, all of which resulted in reduced operating costs and increased revenues. The hospitals participated in a 15-month collaborative project between New Jersey Hospital Association member hospitals and the Boston-based Institute for Healthcare Optimization (IHO). The initiative was funded through the Affordable Care Act as a Centers for Medicare and Medicaid Services (CMS) “hospital engagement network."

According to Mary Ditri, director of professional practice at the New Jersey Hospital Association, hospitals involved in the collaborative analyzed the inefficiencies in their operations, which included uneven usage of operating rooms that often led to long waits, overtime costs and cancellation of procedures at peak times and wages paid to idle staff during low usage. Some hospitals also identified bottlenecks in admitting patients to inpatient beds, which forced many patients to wait long periods in the emergency department or in post-surgery units.

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In order to begin focusing on improving bottlenecks in the ED or shorten hospital stays, the hospitals had to first focus on an intensive self-assessment to understand which processes were working well within the hospital and which ones weren’t.

“To begin the process at each hospital there was a comprehensive self-assessment right out of the gate. The hospitals were in charge of putting teams together at their organization and analyzing their current processes. This included input from the finance department,” said Ditri. “It was then the team’s responsibility to engage frontline staff and the C-suite to educate them on the intuitive.”

Ditri explained that for all participating hospitals, it was crucial “to create buy-in at the C-suite level right from the beginning, including finance. Otherwise, this initiative wouldn’t have happened. You really need to have executive leadership champion this type of initiative. Without that support, you’re going to struggle. Our most successful hospitals were the ones where their CFO was engaged from the beginning.”

William DiStanislao, senior manager of quality and outcomes at one of the collaboration’s participating hospitals, Ocean Medical Center in Brick, N.J., agreed that “commitment from your organization from the top down” is important in order to get project implementation off the ground.

“It required full-time effort in order to get all the results we needed,” he said.

At another one of the collaboration’s hospitals, Monmouth Medical Center in Long Branch, N.J., Catherine Crosbie, perioperative systems analyst, said that there was a major bottlenecking problem at the hospital's outpatient units.

“When we got into this project, we wanted to smooth out the outpatient volume throughout the week. We realized we needed more infrastructure over the weekend and overall, the unit needed more attention than it was getting,” she said.

[See also: Hospital alliance says some quality reporting too costly]

In order to fix the problems, a lot of data collection needed to happen first, Crosbie explained, which involved a lot of time and dedicated staff members.

“It took a lot of planning and analysis with both administration support and physician support,” she said. “You can’t make this project successful without physicians on board. They help drive this and the changing of their schedules.”

DiStanislao added that communication between all staff members involved was key.

“Having everyone informed - that’s the structure that works here. The more information everyone has, the better it works,” he said.

At Newark Beth Israel Medical Center in Newark, N.J., Robert Lahita, chairman of the Department of Medicine, said that redirecting patients in their telemetry units was their central focus in the initiative.

In order to streamline the number of patients coming in and out of those units, Lahita explained that screening every single patient admitted with clearly-defined criteria was extremely important.

“Everyone received a printed card with the admissions criteria for the telemetry units. It improves flow and efficiency at our hospital,” he said. “We also began the process with a number of goals and benchmarks in place to check on a weekly basis, which was important.”

Overall, the new processes used by the 14 hospitals seem to have had positive effects on the organizations, according to Ditri.

Following the 15-month initiative, the NJHA found that 11,800 to 17,300 additional patients could be treated without adding inpatient beds or operating rooms; roughly 20,000 additional patients could be accommodated in hospital emergency departments; there was a 21 percent to 85 percent decrease in wait times for emergency department patients to be admitted to a hospital bed; and there were reductions in the length of hospital stays ranging from 3 percent to 47 percent for certain groups of patients.