When leaders at Hackensack Meridian Health's Southern Ocean Medical Center in Manahawkin, N.J., realized that mounting lists of patients in the emergency department waiting room were also stressing out ED clinicians, the hospital went from a "pull to full" model to "pull to infinity."
With the implementation of the new program, the hospital no longer uses its waiting room nor its triage rooms, Michele Morrison, RN, president and chief hospital executive, told Becker's. Instead, every patient who enters the ED checks in and is brought directly back to what Ms. Morrison calls the "triage hallway."
Prior to implementing the Pull to Infinity program in June 2022, the average time to see a physician in the emergency department at Southern Ocean Medical Center was 22 minutes (January to May 2022).
Ms. Morrison said this year, from January to March, that time was reduced to seven minutes.
Clearly, there's reason to understand why the hospital's employee and physician satisfaction surveys, as well as patient surveys, reflect significant satisfaction with current ED protocols.
What's going on in the triage hallway?
The triage hallway has dedicated nurses and patient care technicians who start care right away, Ms. Morrison said, noting "if a patient comes in with chest pain or stroke-like symptoms, they get prioritized. We're not missing those patients."
ED protocols include Advanced Nursing Initiatives, which allow for some treatments — EKGs, splints for fractures, immediate first aid — to start before a patient is seen by a physician. Once doctor's orders are issued, they are expedited — labs get drawn, imaging gets scheduled and any other treatment ordered is acted upon.
Doctors and nurses "were worried people were not being evaluated in a timely fashion," Ms. Morrison said. "With the triage hallway, the patients are visible to the RNs and physicians at all times, so someone is always watching them. They also have reported feeling relieved that there is not always a list of people who have yet to be seen and are still waiting."
The idea for the initiative came from the top of the healthcare system; Pull to Infinity was already a success at Hackensack (N.J.) University Medical Center. Pre-pandemic, Southern Ocean Medical Center's ED reported about 38,000 patients annually (the most in summer months since the hospital is located at the Jersey Shore). More recently, the hospital's ED census is up a little over 42,000 annually.
"For many patients, the emergency department is really the front door of the hospital," she said. "We realized that if we don't set the stage for a great experience at the beginning, it just doesn't flow through the rest of their hospital visit."
The long triage hallway features recliner chairs, with call bells and curtain dividers for privacy. Each patient is brought back for triage, assessed and prioritized; those requiring immediate attention get fast-tracked depending on the severity of their condition.
Saving time, increasing satisfaction
Time from patient arrival to discharge has been reduced, as well, from 182 minutes to 175 minutes. A reduction in each visit adds up. "You can't speed up how long it takes for lab results to come through from the time you draw blood. We can't speed up the time it takes to do a CT scan or X-ray. Those times are constant," Ms. Morrison said. "But time reduced in other ways adds up. If we have 150 patients a day and shave several minutes off every patient visit, that frees up actual beds and saves more than 15 hours a day!"
The hospital's goal is to reduce that time even further down to 130 minutes per patient.
Additionally, Ms. Morrison said, patients often leave the hospital when they are forced to wait too long. "So another significant metric we are proud of is our 'left before treatment is complete' numbers; we reduced it from 3.5 percent (in calendar year 2022) to 1.6 percent (January to April, 2023)," she said.
"If a patient leaves before treatment, there is a higher risk of them coming back or, worse, having their condition get worse or having other significant medical issues because a problem that needed treatment didn't get it."