JAMIA: ED throughput can be slowed by EHR implementation
Research from Cincinnati Children’s Hospital Medical Center published Nov. 3 in the Journal of the American Medical Informatics Association asserted that its analysis of EHR implementation in a busy pediatric emergency department (ED) should help hospitals and ED groups recognize potential needs when planning their EHR implementation.
“Implementing EHRs in healthcare settings incurs challenges, none more important than maintain efficiency and safety during rollout,” wrote Stephanie Spellman Kennebeck, PhD, from the division of emergency medicine at Cincinnati Children’s Hospital Medical Center, and colleagues.
The researchers sought to quantify the impact of offloading low-acuity visits to alternative care sites from the ED during implementation, as well as evaluate the effect of EHR implementation on overall patient length of stay, time to medical provider and provider productivity during and after EHR implementation. The implementation in the hospital was phased in over two years with the ED portion set for November 2009.
The H1N1 flu pandemic began in their region in late summer of 2009, causing a surge in patient volumes to the ED in September 2009, Kennebeck et al wrote. To cope with the large volume of non-acute patients because of influenza, an overflow clinic was started to divert patients presenting to the ED with flu-like illnesses to an onsite clinic staffed by non-ED providers. Within two weeks, the overflow clinic was seeing 50 to 60 patients a day, approximately 10 to 20 percent of the daily ED volume. By early November 2009, volumes of flu patients declined to pre-surge averages.
During the overflow clinic activation and before EHR implementation nearly 10 percent of patients were diverted to the overflow clinic; however, only 5 percent were diverted during EHR implementation, according to the researchers.
On average, admitted patients' length of stay was 6 to 20 percent longer. For discharged patients, length of stay was 12 to 22 percent longer, the authors found.
The overflow clinic during the H1N1 surge appeared to reduce the overall length-of-stay before the implementation by 24 to 53 minutes for admissions, and 9 to 19 minutes for discharges. However, during EHR implementation, the overall length-of-stay for both groups exceeded both the H1N1 pre-overflow clinic block as well as the H1N1 overflow clinic block by 32 to 62 minutes for admissions and by 35 to 44 minutes for discharges.
“Attempts to reduce patient volumes by diverting patients to another clinic were not effective in minimizing delays in care during this EHR implementation,” the authors wrote. “Delays in ED throughput during EHR implementation are real and significant despite additional providers in the ED.
“It is difficult to know how much benefit was gained through our interventions of increased staffing and limited diversion of low acuity patients. However, despite these interventions, we found patient metrics returned to baseline levels by three months,” the authors concluded. “Further study is needed to identify potential safeguards to ensure patient safety during such a period of operational change.”
“Implementing EHRs in healthcare settings incurs challenges, none more important than maintain efficiency and safety during rollout,” wrote Stephanie Spellman Kennebeck, PhD, from the division of emergency medicine at Cincinnati Children’s Hospital Medical Center, and colleagues.
The researchers sought to quantify the impact of offloading low-acuity visits to alternative care sites from the ED during implementation, as well as evaluate the effect of EHR implementation on overall patient length of stay, time to medical provider and provider productivity during and after EHR implementation. The implementation in the hospital was phased in over two years with the ED portion set for November 2009.
The H1N1 flu pandemic began in their region in late summer of 2009, causing a surge in patient volumes to the ED in September 2009, Kennebeck et al wrote. To cope with the large volume of non-acute patients because of influenza, an overflow clinic was started to divert patients presenting to the ED with flu-like illnesses to an onsite clinic staffed by non-ED providers. Within two weeks, the overflow clinic was seeing 50 to 60 patients a day, approximately 10 to 20 percent of the daily ED volume. By early November 2009, volumes of flu patients declined to pre-surge averages.
During the overflow clinic activation and before EHR implementation nearly 10 percent of patients were diverted to the overflow clinic; however, only 5 percent were diverted during EHR implementation, according to the researchers.
On average, admitted patients' length of stay was 6 to 20 percent longer. For discharged patients, length of stay was 12 to 22 percent longer, the authors found.
The overflow clinic during the H1N1 surge appeared to reduce the overall length-of-stay before the implementation by 24 to 53 minutes for admissions, and 9 to 19 minutes for discharges. However, during EHR implementation, the overall length-of-stay for both groups exceeded both the H1N1 pre-overflow clinic block as well as the H1N1 overflow clinic block by 32 to 62 minutes for admissions and by 35 to 44 minutes for discharges.
“Attempts to reduce patient volumes by diverting patients to another clinic were not effective in minimizing delays in care during this EHR implementation,” the authors wrote. “Delays in ED throughput during EHR implementation are real and significant despite additional providers in the ED.
“It is difficult to know how much benefit was gained through our interventions of increased staffing and limited diversion of low acuity patients. However, despite these interventions, we found patient metrics returned to baseline levels by three months,” the authors concluded. “Further study is needed to identify potential safeguards to ensure patient safety during such a period of operational change.”