HMH Palisades Medical Center Emergency Department

North Bergen, New Jersey

With nearly 55,000 annual ED visits, Palisades Medical Center redesigned Fast Track around direct bedding by Emergency Severity Index, two-nurse peak staffing, nurse-driven protocols and two advanced practice providers. The workflow enabled nursing assessment and intervention within 10 minutes of arrival while accelerating diagnostics, treatment and disposition. During staffing constraints, a nurse–patient care technician team preserved flow. Fast Track length of stay declined from 173 minutes in the first quarter of 2024 to 117 minutes in the fourth quarter of 2025, surpassing the 120-minute goal and demonstrating sustained, nursing-led gains in access, efficiency and patient experience.

Palisades Medical Center also strengthened medication safety after audits identified opportunities to improve controlled-substance handling and reconciliation. The ED added a secondary signed narcotic log, maintained dual verification for waste and returns, introduced medication profiling to eliminate overrides, and partnered with pharmacy to review orders and waste documentation. Systemwide analytics supported monitoring, while discrepancies prompted immediate investigation and leadership follow-up. These safeguards improved accountability and reduced reported narcotic variances from 110 in 2024 to 41 in 2025, a 63 percent decrease that reflects a sustained culture of patient and staff safety.