Impact of electronic health record implementation on patient flow metrics in a pediatric emergency department

Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
Journal of the American Medical Informatics Association (Impact Factor: 3.5). 11/2011; 19(3):443-7. DOI: 10.1136/amiajnl-2011-000462
Source: PubMed


Implementing electronic health records (EHR) in healthcare settings incurs challenges, none more important than maintaining efficiency and safety during rollout. This report quantifies the impact of offloading low-acuity visits to an alternative care site from the emergency department (ED) during EHR implementation. In addition, the report evaluated the effect of EHR implementation on overall patient length of stay (LOS), time to medical provider, and provider productivity during implementation of the EHR. Overall LOS and time to doctor increased during EHR implementation. On average, admitted patients' LOS was 6-20% longer. For discharged patients, LOS was 12-22% longer. Attempts to reduce patient volumes by diverting patients to another clinic were not effective in minimizing delays in care during this EHR implementation. Delays in ED throughput during EHR implementation are real and significant despite additional providers in the ED, and in this setting resolved by 3 months post-implementation.

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Available from: Michael K Farrell, May 18, 2014
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    • "This experience discrepancy may have had an effect on the data collected as there is a chance efficiencies may be gained with continued use. However, Kennebeck et al. reported a return to a steady-state workflow after 3 months of implementing a EHR in a pediatric ED.20 It is unknown the magnitude of efficiency gains that would occur after 10 months of continued use of the voice recognition data entry system. "
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    ABSTRACT: Introduction Use of electronic health record (EHR) systems can place a considerable data entry burden upon the emergency department (ED) physician. Voice recognition data entry has been proposed as one mechanism to mitigate some of this burden; however, no reports are available specifically comparing emergency physician (EP) time use or number of interruptions between typed and voice recognition data entry-based EHRs. We designed this study to compare physician time use and interruptions between an EHR system using typed data entry versus an EHR with voice recognition. Methods We collected prospective observational data at 2 academic teaching hospital EDs, one using an EHR with typed data entry and the other with voice recognition capabilities. Independent raters observed EP activities during regular shifts. Tasks each physician performed were noted and logged in 30 second intervals. We compared time allocated to charting, direct patient care, and change in tasks leading to interruptions between sites. Results We logged 4,140 minutes of observation for this study. We detected no statistically significant differences in the time spent by EPs charting (29.4% typed; 27.5% voice) or the time allocated to direct patient care (30.7%; 30.8%). Significantly more interruptions per hour were seen with typed data entry versus voice recognition data entry (5.33 vs. 3.47; p=0.0165). Conclusion The use of a voice recognition data entry system versus typed data entry did not appear to alter the amount of time physicians spend charting or performing direct patient care in an ED setting. However, we did observe a lower number of workflow interruptions with the voice recognition data entry EHR. Additional research is needed to further evaluate the data entry burden in the ED and examine alternative mechanisms for chart entry as EHR systems continue to evolve.
    The western journal of emergency medicine 07/2014; 15(4):541-7. DOI:10.5811/westjem.2014.3.19658
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    • "A systematic examination of variability in terms of activities, roles and sequences in patient care generates a deeper understanding of the complex cooperative work in EDs. Such an understanding can lead to the design, implementation and evaluation of systematic engineering interventions to increase efficiency (Welch et al, 2007; Welch et al, 2011; Spellman Kennebeck et al, 2012), improve service quality and safety (Hoot & Aronsky, 2008; Bernstein et al, 2009), and decrease cost (Frisse et al, 2012). "
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    ABSTRACT: The purpose of this study is to characterize the early stage (i.e., until first prescriber order) of patient care in emergency departments (EDs) by focusing on the temporal sequence of activities by multiple roles. A hundred and eight patient care episodes in three EDs were observed and modeled as patient-oriented workflows. Capturing individual episodes allowed us to account for cooperative work in EDs. Data analysis revealed a high level of variability across patient care episodes. We also identified six patterns differentiated primarily by whether the prescriber is a physician or midlevel clinician. Secondary differentiators included whether the patient arrived in the ED as walk-in or via ambulance, and in which ED the patient care occurred. The high level of workflow variability reported in this study should be recognized in the design of ED work systems. Moreover, work interventions should not limit EDs’ capacity to handle sequential variability in patient care.
    Health System 10/2012; 1(2). DOI:10.1057/hs.2012.14
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    ABSTRACT: Information technology (IT) has profoundly changed the delivery of health care during the past decade. The pediatric emergency department (ED) represents a specific challenge for applying IT systems to the patient bedside. The rapid pace and unscheduled nature of the ED, the breadth of care delivered, and the range of medical, ethical, cultural, and process issues presented by pediatric patients make this a setting in particular need of thoughtfully designed and usable IT systems. However, reviews of the current state of health IT have documented mixed outcomes, including safety risks introduced by IT systems, significant deficits in usability for clinicians, and unrealized potential. Although some publications have presented methods and outcomes of IT systems in the pediatric ED, the current medical literature is sparse. Professional organizations have not developed successful methods to share best practices across institutions and IT vendors. The authors propose a new section of this journal focused on the application of IT systems to Pediatric Emergency Care. The section will include original research articles and reviews focusing on the application of IT to improve care of acutely ill and injured children. Innovative approaches and articles by physicians in training are particularly encouraged to develop new expertise in informatics within this and related specialties.
    Pediatric emergency care 12/2012; 28(12):1399-1401. DOI:10.1097/PEC.0b013e31827d909e · 1.05 Impact Factor
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