Tech Treatment: NJIT Re-engineering Team Helps Local Emergency Department
Saint Barnabas Medical Center (SBMC) in Livingston, N.J., is no stranger to accolades. Among other notable rankings, the acute-care teaching hospital has received 16 A ratings in a row from the Leapfrog Hospital Safety Grade, and is one of less than 41 hospitals in the country to achieve this consistency.
The hospital was seeking to further improve its delivery of patient care by reducing emergency department (ED) delays. Upon learning of this objective as an invited guest at an SBMC leadership meeting, NJIT knew it could help and offered to apply the collective know-how of its Martin Tuchman School of Management (MTSM), Newark College of Engineering (NCE) and New Jersey Innovation Institute (NJII). The goal was to study the patient workflow in the ED and then identify innovative process improvements in design and operation to prevent delays and congestion.
This process re-engineering project, welcomed by SBMC, involved both faculty and students. MTSM Associate Professor of Finance Michael Ehrlich initiated the connection and served as a project lead along with NCE Professor of Mechanical and Industrial Engineering Sanchoy Das and NJII Executive Head of Operations Lynn Wilson. Abubaker-sadiq Abdulai, MTSM Ph.D. student; Jingran Zhang, industrial engineering Ph.D. student; and Varun Balaji, industrial engineering M.S. student, rounded out the team.
“Health care analysis projects require an integrated view to be successful,” noted Das, who brought a wealth of operational and research experience in health care systems and industrial engineering to the undertaking. “This project brought together deep knowledge in data analysis and process modeling from NCE, economic and quality analysis from MTSM and hospital procedural experience from NJII.”
Wilson agreed, specifying that the NJIT team, with its deep analytical skills, “mapped the processes, collected the relevant data and then created illustrations of what was actually happening” in the ED, ultimately identifying opportunities for improvement.
Telling Timeline
The project was completed over four months, from April to August of this year. After a discovery period that included an introductory walk-through of the ED, subsequent on-site visits to track patient entry and registration to discharge or admission, and interviews with ED and bed-management staff, the NJIT team moved into a data-analytics phase. For this stage, it used its observations of the ED activity along with six months worth of ED patient-flow timestamp data, provided by SBMC, that focused on ED arrival and discharge, triage administration and bed assignments for admitted patients.
Zhang applied her data analytics and process modeling acumen to extract critical intelligence from the records of more than 50,000 patients. With this intelligence and those insights gleaned from the on-site visits, Balaji then employed process mapping and analysis techniques to trace the ED patient flow and pinpoint operational and care-decision bottlenecks.
The visits were vital, because they “allowed us to get an unadulterated viewpoint into the bottlenecks experienced by the floor nurses — the people who are truly impacted by delays — as well as a patient’s stay in the ED and any issues that came up during the stay,” said Balaji, who is now working full time at NJII as an operations analyst. “I hadn’t had the opportunity to actually utilize what my master’s courses were teaching me. Trying to optimize the ED’s operational efficiency, especially under the guidance of Dr. Das, really helped me realize the value of these courses and introduce myself to techniques that I was yet to learn.”
The team’s research revealed a series of performance hurdles affecting patient flow that involved numerous aspects of the process.
Actionable Answers
With the discovery period and data-analytics phases concluded, the NJIT team convened for the third stage of the project: identifying opportunities for process improvement and developing practical solutions.
“NJIT met with various stakeholders within the ED, where they presented their data collection findings,” said Christopher F. Freer, D.O., FACEP, chairman, Department of Emergency Medicine, SBMC, and regional medical director, Emergency Services, RWJBarnabas Health. “The team was able to objectively evaluate current situations without built-in bias, thus providing a clarity to provide alternatives to current practices.”
“SBMC had already collected an enormous amount of data, but they did not have the resources or capability to conduct the type of analysis for this process re-engineering challenge,” Ehrlich added. “The data analysis and visualizations allowed the team and SBMC to understand the problems and opportunities so that we could suggest appropriate solutions that were both doable and supported by best practices from the literature.”
He and the team compiled a comprehensive report, in consultation with SBMC leaders, outlining the team’s conclusions about and ideas for enhancing ED efficiency. Each of the 11 recommendations included an implementation plan, an industry example and projected benefits. Among those that SBMC has already put into action are designing a nursing schedule that staggers shifts based on patient arrivals and flow; employing standing orders to administer blood tests to arriving patients when the ED is full, so that results are typically back when the patient is seen by a practitioner and care is expedited; and expanding an area within the ED to facilitate treatment of low-acuity patients.
Pleased with the team’s recommendations, which should serve to improve patient experience, time management and throughput in the ED, Carmelita Manning, M.S.N., R.N.-B.C., administrative director of the SBMC ED, looks forward to implementing more suggestions in the future.
The value of working with NJIT “allowed for more diverse ideas and solutions to assist with our departmental performance,” she remarked. “Their experience with outside organizations and data collection from our facility assisted in the development of new strategies and creative solutions to enable us to ‘think outside of the box’ in terms of our departmental throughput.”
Following on the heels of this successful collaboration, the NJIT team has begun working with SBMC on a second process re-engineering project: reducing length of stay (LOS). In today’s health care environment, low LOS coupled with positive patient outcomes and cost-effectiveness is a key indicator of efficiency.
Ehrlich and Das view these and future projects with the hospital as perfect tie-ins to MTSM’s mission — and really that of NJIT overall — of engagement, innovation and impact. “We engaged SBMC leadership and selected a high-priority problem they posed. Once we collected and analyzed the data … we were able to innovate to suggest new solutions that would help them to streamline the SBMC emergency department. The SBMC team immediately adopted several ideas … that created an immediate impact to improve the ED efficiency,” he pointed out, adding that the partnership continues with an eye toward increasing the NJIT team’s impact at SBMC even more.
