scholarly journals The impact of computerized provider order entry on emergency department flow

CJEM ◽  
2016 ◽  
Vol 18 (4) ◽  
pp. 264-269 ◽  
Author(s):  
Andrew Gray ◽  
Christopher M.B. Fernandes ◽  
Kristine Van Aarsen ◽  
Melanie Columbus
Keyword(s):  
Emergency Department ◽  
Patient Safety ◽  
Improve Patient Safety ◽  
Patient Flow ◽  
Wait Time ◽  
Order Entry ◽  
Computerized Provider Order Entry ◽  
Left Without Being Seen ◽  
Before And After ◽  
The Impact

AbstractObjectivesComputerized provider order entry (CPOE) has been established as a method to improve patient safety by avoiding medication errors; however, its effect on emergency department (ED) flow remains undefined. We examined the impact of CPOE implementation on three measures of ED throughput: wait time (WT), length of stay (LOS), and the proportion of patients that left without being seen (LWBS).MethodsWe conducted a retrospective cohort study of all ED patients of 18 years and older presenting to London Health Sciences Centre during July and August 2013 and 2014, before and after implementation of a CPOE system. The three primary variables were compared between time periods. Subgroup analyses were also conducted within each Canadian Triage and Acuity Scale (CTAS) level (1–5) individually, as well as for admitted patients only.ResultsA significant increase in WT of 5 minutes (p=0.036) and LOS of 10 minutes (p=0.001), and an increase in LWBS from 7.2% to 8.1% (p=0.002) was seen after CPOE implementation. Admitted patients’ LOS increased by 63 minutes (p<0.001), the WT of CTAS 3 and 5 patients increased by 6 minutes (p=0.001) and 39 minutes (p=0.005), and LWBS proportion increased significantly for CTAS 3–5 patients, from 24.3% to 42.0% (p<0.001) for CTAS 5 patients specifically.ConclusionsCPOE implementation detrimentally impacted all patient flow throughput measures that we examined. The most striking clinically relevant result was the increase in LOS of 63 minutes for admitted patients. This raises the question as to whether the potential detrimental effects to patient safety of CPOE implementation outweigh its benefits.

scholarly journals Impact of process improvements on measures of emergency department efficiency

CJEM ◽  
2016 ◽  
Vol 19 (2) ◽  
pp. 96-105 ◽  
Author(s):  
Alexander K. Leung ◽  
Shawn D. Whatley ◽  
Dechang Gao ◽  
Marko Duic
Keyword(s):  
Emergency Department ◽  
Patient Flow ◽  
Interrupted Time Series ◽  
Initial Assessment ◽  
Interrupted Time Series Analysis ◽  
Post Intervention ◽  
Process Improvements ◽  
Left Without Being Seen ◽  
Clinically Significant ◽  
The Impact

AbstractObjectiveTo study the operational impact of process improvements on emergency department (ED) patient flow. The changes did not require any increase in resources or expenditures.MethodsThis was a 36-month pre- and post-intervention study to evaluate the effect of implementing process improvements at a community ED from January 2010 to December 2012. The intervention comprised streamlining triage by having patients accepted into internal waiting areas immediately after triage. Within the ED, parallel processes unfolded, and there was no restriction on when registration occurred or which health care provider a patient saw first. Flexible nursing ratios allowed nursing staff to redeploy and move to areas of highest demand. Last, demand-based physician scheduling was implemented. The main outcome was length of stay (LOS). Secondary outcomes included time to physician initial assessment (PIA), left-without-being-seen (LWBS) rates, and left-against-medical-advice (LAMA) rates. Segmented regression of interrupted time series analysis was performed to quantify the impact of the intervention, and whether it was sustained.ResultsPatients totalling 251,899 attended the ED during the study period. Daily patient volumes increased 17.3% during the post-intervention period. Post-intervention, mean LOS decreased by 0.64 hours (p<0.005). LOS for non-admitted Canadian Triage and Acuity Scale 2 (-0.58 hours, p<0.005), 3 (-0.75 hours, p<0.005), and 4 (-0.32 hours, p<0.005) patients also decreased. There were reductions in PIA (43.81 minutes, p<0.005), LWBS (35.2%, p<0.005), and LAMA (61.9%, p<0.005).ConclusionA combination of process improvements in the ED was associated with clinically significant reductions in LOS, PIA, LWBS, and LAMA for non-resuscitative patients.

scholarly journals Multimorbidity Clustering of the Emergency Department Patient Flow: Impact Analysis of New Unscheduled Care Clinics

2020 ◽  
Author(s):  
Adrien Wartelle ◽  
Farah Mourad-Chehade ◽  
Farouk Yalaoui ◽  
Hélène Questiaux ◽  
Thomas Monneret ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Departments ◽  
Patient Flow ◽  
Temporal Trends ◽  
Healthcare Delivery ◽  
Period Effect ◽  
Care Services ◽  
Unscheduled Care ◽  
Before And After ◽  
The Impact

Abstract Background: In France, the number of admissions to emergency departments doubled between 1996 and 2016, leading to overcrowding. To cope with the resultant overcrowding, redirecting patients to new healthcare services is a viable solution, to spread demand more evenly across available healthcare delivery points, and render care more efficient. The goal of this study was to analyse the impact of opening new unscheduled care services on variations in patient attendance at a large emergency department. Methods: We performed a before-and-after study investigating the use of unscheduled care services in the Aube Department (Eastern France), focusing on emergency department attendance of Troyes Hospital. We applied a hierarchical clustering based on co-occurrence of diagnoses, to divide the population into different multimorbidity profiles and study their temporal trends. A multivariate logistic regression model was constructed to adjust the period effect for appropriate confounders. Results: In total, 120,718 visits to the emergency department were recorded over a 24-month period (2018-2019), and 14 clusters were identified accounting for 94.76% of all visits. The before-and-after analysis showed a decrease of 57.95 visits per week in 7 specific clusters, while the consumption of unscheduled health care services increased by 328.12 visits per week.Conclusions: Using an innovative and reliable methodology to evaluate changes in patient flow through the emergency department, our results could help to inform public health policy regarding the implementation of unscheduled care services, to ease pressure on emergency departments.

What Did You Order? Developing Models to Measure the Impact of Usability on Emergency Physician Accuracy Using Computerized Provider Order Entry

2019 ◽  
Vol 63 (1) ◽  
pp. 713-717
Author(s):  
Swaminathan Kandaswamy ◽  
Aaron Z Hettinger ◽  
Raj M. Ratwani
Keyword(s):  
Improve Patient Safety ◽  
Usability Study ◽  
Order Entry ◽  
Test Environment ◽  
Cross Sectional ◽  
Health Records ◽  
Computerized Provider Order Entry ◽  
Clinical Environments ◽  
The Impact ◽  
Improve Patient

Computerized Provider Order Entry (CPOE) is a critical component of electronic health records (EHR). Although widely adopted, the usability of these systems is not well understood. A cross-sectional usability study was conducted at four healthcare systems using two commercially available EHRs. This research aims to predict the accuracy of an order placed in the EHR by emergency medicine physicians. Physician-EHR interactions were recorded during six simulated task scenarios in a test environment. The data from 222 interactions were used to predict the accuracy of the order placed. Multiple models were developed, and their performance was compared. The Random Forest model had the best performance with F1 score 0.82 and AUC of 0.89. These results demonstrate the utility of using keystroke, time and user demographics as variables in predicting accurate order placement. Applying such models to passively monitor EHR usage in real world clinical environments may help improve patient safety and care.

scholarly journals LO56: Novel role of physician navigators on performance indicators in the emergency department

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S47
Author(s):  
A. Leung ◽  
G. Puri ◽  
B. Chen ◽  
Z. Gong ◽  
E. Chan ◽  
...  
Keyword(s):  
Emergency Department ◽  
Patient Care ◽  
Mixed Linear Model ◽  
Primary Objective ◽  
Initial Assessment ◽  
Direct Patient Care ◽  
Healthcare Team ◽  
Left Without Being Seen ◽  
Before And After ◽  
The Impact

Introduction: Burnout rates for emergency physicians (EP) continue to be amongst the highest in medicine. One of the commonly cited sources of stress contributing to disillusionment is bureaucratic tasks that distract EPs from direct patient care in the emergency department (ED). The novel position of Physician Navigator was created to help EPs decrease their non-clinical workload during shifts, and improve productivity. Physician Navigators are non-licensed healthcare team members that assist in activities which are often clerical in nature, but directly impact patient care. This program was implemented at no net-cost to the hospital or healthcare system. Methods: In this retrospective study, 6845 clinical shifts worked by 20 EPs over 39 months from January 1, 2012 to March 31, 2015 were evaluated. The program was implemented on April 1, 2013. The primary objective was to quantify the effect of Physician Navigators on measures of EP productivity: patient seen per hour (Pt/hr), and turn-around-time (TAT) to discharge. Secondary objectives included examining the impact of Physician Navigators on measures of ED throughput for non-resuscitative patients: emergency department length of stay (LOS), physician-initial-assessment times (PIA), and left-without-being-seen rates (LWBS). A mixed linear model was used to evaluate changes in productivity measures between shifts with and without Physician Navigators in a clustered design, by EP. Autoregressive modelling was performed to compare ED throughput metrics before and after the implementation of Physician Navigators for non-resuscitative patients. Results: Across 20 EPs, 2469 shifts before, and 4376 shifts after April 1, 2013 were analyzed. Daily patient volumes increased 8.7% during the period with Physician Navigators. For the EPs who used Physician Navigators, Pt/hr increased by 1.07 patients per hour (0.98 to 1.16, p&lt;0.001), and TAT to discharge decreased by 10.6 minutes (-13.2 to -8.0, p&lt;0.001). After the implementation of the Physician Navigators, overall LOS for non-resuscitative patients decreased by 2.6 minutes (1.0%, p=0.007), and average PIA decreased by 7.4 minutes (12.0%, p&lt;0.001). LBWS rates decreased by 43.9% (0.50% of daily patient volume, p&lt;0.001). Conclusion: The use of a Physician Navigator was associated with increased EP productivity as measured by Pt/hr, and TAT to discharge, and reductions in ED throughput metrics for non-resuscitative patients.

scholarly journals Evaluating the Impact of the Electronic Health Record on Patient Flow in a Pediatric Emergency Department

2011 ◽  
Vol 02 (01) ◽  
pp. 39-49 ◽  
Author(s):  
JM Chamberlain ◽  
DJ Mathison
Keyword(s):  
Emergency Department ◽  
Patient Flow ◽  
Pediatric Emergency ◽  
Outcome Variable ◽  
Inclusion Criteria ◽  
Medical Provider ◽  
External Variables ◽  
Before And After ◽  
The Mean ◽  
The Impact

Summary Background: There is little data on the effect of the EHR on emergency department (ED) efficiency. Objective: 1) to quantify the effect of the EHR on patient flow in an academic pediatric ED. 2) to analyze the effects of patient census, boarding time, staffing hours, and acuity on the mean daily ED length-of-stay (LOS) and triage-to-provider time. Methods: ED performance was compared before and after the implementation of an EHR in May 2008. Six month intervals were used with a 5 month period of adjustment between the pre- and post-EHR intervals. 34791 patient visits met inclusion criteria. Multiple linear regression was used to evaluate the LOS and triage-to-provider time as influenced by internal and external variables affecting the ED. Results: Daily patient census increased by 5.8% (p<0.01) without a change in rate of ED admissions. Nursing and practitioner hours increased by 19.7% and 16.1%, respectively because of the increased census and a perceived slowing associated with the EHR. Following the implementation, LOS remained unchanged while triage-to-provider time increased by 5 minutes per patient (p<0.05). Factors that independently affected both LOS and triage-to-provider time included census, acuity, and practitioner hours (p<0.05). When controlling for these independent variables, the use of an EHR did not affect either outcome variable (p=0.251, 0.074 respectively). However, patient flow was worsened with the EHR during days of extremely high patient census. Conclusion: An ED-EHR was associated with a modest increase in time to see a medical provider but was not associated with a change in overall LOS. When controlling for factors including patient volume, acuity, and staffing, the EHR did not independently affect ED patient flow. The EHR may have a more profound impact on ED performance during periods of extremely high census.

Computerized provider order entry system: Solution to improve patient safety

2013 ◽  
Vol 1 (3) ◽  
pp. 180
Author(s):  
Mahtab Kasaei ◽  
Fahimeh Sadeghi ◽  
Sakineh Saghaeiannejad ◽  
Vahideh Shirzad ◽  
Nahid Tavakoli ◽  
...  
Keyword(s):  
Patient Safety ◽  
Improve Patient Safety ◽  
Order Entry ◽  
Computerized Provider Order Entry ◽  
System Solution ◽  
Improve Patient

scholarly journals A Risk Analysis Method to Evaluate the Impact of a Computerized Provider Order Entry System on Patient Safety

2008 ◽  
Vol 15 (4) ◽  
pp. 453-460 ◽  
Author(s):  
P. Bonnabry ◽  
C. Despont-Gros ◽  
D. Grauser ◽  
P. Casez ◽  
M. Despond ◽  
...  
Keyword(s):  
Patient Safety ◽  
Risk Analysis ◽  
Analysis Method ◽  
Order Entry ◽  
Computerized Provider Order Entry ◽  
The Impact

scholarly journals The Impact of a Concierge Medicine Model on Door to Doctor Time and Patient Flow in an Urban Emergency Department

2020 ◽  
Vol Volume 12 ◽  
pp. 13-18
Author(s):  
Asher L Mandel ◽  
Thomas Bove ◽  
Amisha D Parekh ◽  
Paris Datillo ◽  
Joseph Bove Jr ◽  
...  
Keyword(s):  
Emergency Department ◽  
Patient Flow ◽  
The Impact ◽  
Urban Emergency Department

Quality and Patient Safety in a Pathology Residency Training Program

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S95-S96
Author(s):  
R Demkowicz ◽  
S Sapatnekar ◽  
D Chute
Keyword(s):  
Patient Safety ◽  
Residency Training ◽  
Chief Resident ◽  
Residency Training Program ◽  
Basic Structure ◽  
Learning Activities ◽  
Before And After ◽  
Quality And Patient Safety ◽  
The Impact ◽  
Quiz Scores

Abstract Introduction/Objective Since the start of the new millennium, optimization of Quality and Patient Safety (QPS) has taken a renewed focus in the healthcare industry. Consequently, the Accreditation Council for Graduate Medical Education has mandated that QPS be a part of residency training. We have previously presented our curriculum designed to meet the specific needs of Pathology training programs, and covering four content areas: Handoffs, Error Management, Laboratory Administration, and Process Improvement. We are now presenting implementation. Methods To implement this curriculum, we 1) created online modules for self-directed learning on basic topics (using courses developed by IHI and CAP, and assigned articles), and paired these with faculty-facilitated interactive learning activities on more complex topics, including proficiency testing, root cause analysis and test utilization, 2) assigned every resident to a QPS project that was aligned with departmental priorities, led by a faculty advisor, and ran over 8- 10 months, and 3) appointed a QPS Chief Resident to coordinate and support the residents’ QPS activities. We measured the impact of the curriculum by comparing RISE laboratory accreditation percentiles and QPS curriculum quiz scores before and after curriculum implementation. Results After its implementation, RISE percentiles increased by at least 25 for every PGY, and QPS quiz scores increased by at least 10% for 3 of 4 PGY. Every QPS project was presented at Grand Rounds, and 4 were presented externally, including 2 at national conferences. Conclusion Our curriculum was successful in improving residents’ knowledge and competence in QPS. Challenges included designing appropriate learning activities, tracking completion of activities, coordinating faculty schedules and maintaining resident buy-in to the curriculum. We believe that the basic structure of our curriculum offers a solid foundation to which revisions can be made as QPS priorities evolve, and which can be readily adapted to other programs and locations.

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