the international council on medical & care compunetics


December, 2014

emergency department

Quality and Safety Implications of Emergency Department Information Systems

Farley HL et al, Annals of Emergency Medicine, 2013

The Health Information Technology for Economic and Clinical Health Act of 2009 and the Centers for Medicare & Medicaid Services “meaningful use” incentive programs, in tandem with the boundless additional requirements for detailed reporting of quality metrics, have galvanized hospital efforts to implement hospital-based electronic health records. As such, emergency department information systems (EDISs) are an important and unique component of most hospitals’ electronic health records. System functionality varies greatly and affects physician decisionmaking, clinician workflow, communication, and, ultimately, the overall quality of care and patient safety. This article is a joint effort by members of the Quality Improvement and Patient Safety Section and the Informatics Section of the American College of Emergency Physicians. The aim of this effort is to examine the benefits and potential threats to quality and patient safety that could result from the choice of a particular EDIS, its implementation and optimization, and the hospital’s or physician group’s approach to continuous improvement of the EDIS. Specifically, we explored the following areas of potential EDIS safety concerns: communication failure, wrong order–wrong patient errors, poor data display, and alert fatigue.
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26 June 2013 | No Comments »
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Health information exchange technology on the front lines of healthcare: workflow factors and patterns of use

Unertl KM et al, J Am Med Inform Assoc, 19(3)

The goal of this study was to develop an in-depth understanding of how a health information exchange (HIE) fits into clinical workflow at multiple clinical sites.

Materials and Methods
The ethnographic qualitative study was conducted over a 9-month period in six emergency departments (ED) and eight ambulatory clinics in Memphis, Tennessee, USA. Data were collected using direct observation, informal interviews during observation, and formal semi-structured interviews. The authors observed for over 180 h, during which providers used the exchange 130 times.
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16 May 2012 | No Comments »
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A Randomized Controlled Trial of Telemonitoring in Older Adults With Multiple Health Issues to Prevent Hospitalizations and Emergency Department Visits

Takahashi PY et al, Archives of Internal Medicine, 2012

Efficiently caring for frail older adults will become an increasingly important part of health care reform; telemonitoring within homes may be an answer to improve outcomes. This study sought to assess differences in hospitalizations and emergency department (ED) visits among older adults using telemonitoring vs usual care.
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27 April 2012 | No Comments »
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A randomized trial of computer kiosk-expedited management of cystitis in the emergency department

Stein JC et al, Academic Emergency Medicine, 18(10)

The objective was to assess the efficiency and safety of an interactive computer kiosk module for the management of uncomplicated urinary tract infections (UTI) in emergency departments (EDs).
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24 April 2012 | No Comments »
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Effects of a short text message reminder system on emergency department length of stay

Kim MJ et al, International Journal of Medical Informatics, 2012

Specialty consultations and waiting for admission to a hospital bed are major contributors to increased length of stay and overcrowding in the emergency department. We implemented a computerized short messaging service to inform care providers of patient delay in order to reduce length of stay. The purpose of this study was to evaluate the effects of this strategy on length of stay in the emergency department.
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1 February 2012 | No Comments »
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Health information exchange usage in emergency departments and clinics: the who, what, and why

Johnson KB et al, J Am Med Inform Assoc, 18(5)

Health information exchange (HIE) systems are being developed across the nation. Understanding approaches taken by existing successful exchanges can help new exchange efforts determine goals and plan implementations. The goal of this study was to explore characteristics of use and users of a successful regional HIE.
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23 January 2012 | No Comments »
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Google Flu Trends: Correlation With Emergency Department Influenza Rates and Crowding Metrics

Dugas AF et al, Clinical Infectious Diseases, 2012

Google Flu Trends (GFT) is a novel Internet-based influenza surveillance system that uses search engine query data to estimate influenza activity and is available in near real time. This study assesses the temporal correlation of city GFT data to cases of influenza and standard crowding indices from an inner-city emergency department (ED).
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11 January 2012 | No Comments »
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The impact of electronic health records on care of heart failure patients in the emergency room

Connelly DP et al, J Am Med Inform Assoc, 19(3)

To evaluate if electronic health records (EHR) have observable effects on care outcomes, we examined quality and efficiency measures for patients presenting to emergency departments (ED).

Materials and methods
We conducted a retrospective study of 5166 adults with heart failure in three metropolitan EDs. Patients were termed internal if prior information was in the EHR upon ED presentation, otherwise external. Associations of internality with hospitalization, mortality, length of stay (LOS), and numbers of tests, procedures, and medications ordered in the ED were examined after adjusting for age, gender, race, marital status, comorbidities and hospitalization as a proxy for acuity level where appropriate.
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15 November 2011 | No Comments »
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The financial impact of health information exchange on emergency department care

Frisse ME et al, J Am Med Inform Assoc, 19(3)

To examine the financial impact health information exchange (HIE) in emergency departments (EDs).Materials and MethodsWe studied all ED encounters over a 13-month period in which HIE data were accessed in all major emergency departments Memphis, Tennessee. HIE access encounter records were matched with similar encounter records without HIE access. Outcomes studied were ED-originated hospital admissions, admissions for observation, laboratory testing, head CT, body CT, ankle radiographs, chest radiographs, and echocardiograms. Our estimates employed generalized estimating equations for logistic regression models adjusted for admission type, length of stay, and Charlson co-morbidity index. Marginal probabilities were used to calculate changes in outcome variables and their financial consequences.ResultsHIE data were accessed in approximately 6.8% of ED visits across 12 EDs studied.
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9 November 2011 | No Comments »
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Impact of electronic health record implementation on patient flow metrics in a pediatric emergency department

Kennebeck SS et al, J Am Med Inform Assoc, 2011

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.
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7 November 2011 | No Comments »
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Evaluation of natural language processing from emergency department computerized medical records for intra-hospital syndromic surveillance

Gerbier S et al, BMC Medical Informatics and Decision Making, 11(1)

The identification of patients who pose an epidemic hazard when they are admitted to a health facility plays a role in preventing the risk of hospital acquired infection. An automated clinical decision support system to detect suspected cases, based on the principle of syndromic surveillance, is being developed at the University of Lyon’s Hopital de la Croix-Rousse. This tool will analyse structured data and narrative reports from computerized emergency department (ED) medical records. The first step consists of developing an application (UrgIndex) which automatically extracts and encodes information found in narrative reports. The purpose of the present article is to describe and evaluate this natural language processing system.
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8 August 2011 | No Comments »
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Impact of prior clinical information in an EHR on care outcomes of emergency patients

Theera-Ampornpunt N et al, AMIA, Annual Symposium Proceedings, 2009

A patient’s prior clinical information available electronically can be helpful during the care process, particularly in the emergency department (ED). The effect of such information on quality and efficiency of ED patient care has not been adequately studied. This study uses secondary data to investigate its impact on surrogate measures of care quality and efficiency among 6,143 congestive heart failure, diabetic, and asthmatic patients in 3 EDs.
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1 May 2011 | No Comments »
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Electronic Medical Records and the Efficiency of Hospital Emergency Departments

Furukawa MF. Medical Care Research and Review, 68(1)

This study examined the relationship between electronic medical records (EMR) sophistication and the efficiency of U.S. hospital emergency departments (EDs). Using data from the 2006 National Hospital Ambulatory Medical Care Survey, survey-weighted ordinary least squares regressions were used to estimate the association of EMR sophistication with ED throughput and probability a patient left without treatment.
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18 August 2010 | No Comments »
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Computerized Decision Support for Medication Dosing in Renal Insufficiency: A Randomized, Controlled Trial

Terrell KM et al, Annals of Emergency Medicine, 2010

Study objective
Emergency physicians prescribe several discharge medications that require dosage adjustment for patients with renal disease. The hypothesis for this research was that decision support in a computerized physician order entry system would reduce the rate of excessive medication dosing for patients with renal impairment.
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14 May 2010 | No Comments »
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Innovation in ALC – Evaluation and Lessons Learned from a Pilot of Electronic Resource Matching and Referral to In-patient Rehab/CCC in an Acute Care Organization

Mastouri, Negin et al, ElectronicHealthcare, 8(3)

One of the root causes for Emergency Department (ED) overcrowding stems from challenges with patient flow from acute to post-acute care institutions. Significant improvements to the referral process can be made by moving to an electronic Resource Matching and Referral (RM&R) system, which could be used to facilitate accessing accurate and consistent data relating to referral patterns, waitlists, response times, referral efficiencies, and gaps in programs/services.
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15 March 2010 | No Comments »
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Estimates of Electronic Medical Records in U.S. Emergency Departments

Geisler BP et al, PLoS ONE, 5(2)

Policymakers advocate universal electronic medical records (EMRs) and propose incentives for “meaningful use” of EMRs. Though emergency departments (EDs) are particularly sensitive to the benefits and unintended consequences of EMR adoption, surveillance has been limited. We analyze data from a nationally representative sample of US EDs to ascertain the adoption of various EMR functionalities.
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17 February 2010 | No Comments »
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Longitudinal histories as predictors of future diagnoses of domestic abuse: modelling study

Reis, Ben Y. et al, BMJ, 339 (sep29_1)

To determine whether longitudinal data in patients’ historical records, commonly available in electronic health record systems, can be used to predict a patient’s future risk of receiving a diagnosis of domestic abuse.

Bayesian models, known as intelligent histories, used to predict a patient’s risk of receiving a future diagnosis of abuse, based on the patient’s diagnostic history. Retrospective evaluation of the model’s predictions using an independent testing set.
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30 September 2009 | No Comments »
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Information system design for a hospital emergency department: a usability analysis of software prototypes

Karahoca, Adem et al, Journal of Biomedical Informatics, Article in Press, Accepted Manuscript

Study objective
The purpose of this study is to evaluate the usability of emergency department (ED) software prototypes developed for Tablet personal computers (Tablet PCs) in order to keep electronic health records (EHRs) of patients errorless and accessible through mobile technologies. In order to serve this purpose, two alternative prototypes were developed for Tablet PCs: Mobile Emergency Department Software (MEDS) and Mobile Emergency Department Software Iconic (MEDSI) among which the user might choose the more appropriate one for ED operations based on a usability analysis involving the target users.
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21 September 2009 | No Comments »
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Pediatric critical care telemedicine in rural underserved emergency departments

Heath, Barry et al, Pediatric Critical Care Medicine, 10(5)

A disparity in access to health care exists between rural and urban areas. Although 21% of children in the United States live in rural areas, only 3% of pediatric intensivists practice in rural areas. In an attempt to address this issue, we implemented a program of pediatric critical care telemedicine consultations in rural emergency departments (EDs) and report our results.
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18 September 2009 | No Comments »
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Paper-based versus computer-based records in the emergency department: Staff preferences, expectations, and concerns

Ayatollahi H et al, Health Informatics Journal, 15(3)

Although the potential benefits of computer-based records have been identified in different areas of the healthcare environment, in many settings paper-based records and computer-based records are still used in parallel. In this article, emergency department (ED) staff perspectives about the use of paper- or computer-based records are presented. This was a qualitative study in which data were collected using in-depth semi-structured interviews with the ED staff. The interviews were transcribed verbatim and data were analysed using framework analysis. In total, 34 interviews were undertaken.
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2 September 2009 | No Comments »
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