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Cover Story: ER/ICU Management

230 physicians and 2,100 employees who work across three main campuses: MedWest-Haywood, MedWest-Harris and MedWest-Swain. At MedWest-Haywood, the not-for-profit public hospital licensed for 189 beds cares for 50,000 patients annually and 27,000 ED visits. For five years, Haywood’s ED used a cumbersome legacy system for nursing and physician documentation, which was literally built one page at a time. Roger Coward, R.N., MedWest Health System assistant vice president, emergency services, recalls: “The worst part of the system for the staff was moving through the documentation. As you documented, you had to move in a linear fashion; there were no tabs, and if you went in to the system five pages, you had to back out five pages. Documentation was very time consuming.” Coward, who was hired in 2008 to re-engineer ED operations, noted that an analysis of the system’s homegrown charge capture revealed documentation of a significant amount of care services rendered were missing; and a discharged patient’s average length of stay (ALOS) in the ED averaged close to four hours, while an admitted patient’s ALOS hovered at seven hours.

Haywood implemented its EDIS in 2010, and process improvement in patient documentation was “realized almost overnight.” A discharged patient’s ALOS in the ED decreased 27 percent to 2.8 hours. An admitted patient’s ALOS decreased 29 percent, from seven hours to less than five hours. Patients’ satisfaction improved when their time was shortened and when given new, easy-to-understand discharge instructions. Regulatory compliance also improved considerably. Haywood ED employees used to spend long hours identifying new changes in Centers for Medicaid & Medicare Services

(CMS) and The Joint Commission regulations and then manually implementing them. Today, the EDIS vendor monitors regulatory changes and accordingly updates the system to keep the hospital ED current with compliance issues. Recently, CMS visited twice to address a complaint and found no deficiencies in documentation after reviewing 50 ED patient records.

In addition to the EDIS implementation, computers were moved to patient rooms to enhance workflow, and tablets were given to nurses and physicians to assist with EHR portability. Bedside registration and point-of-care testing were instituted for faster turnaround of lab and radiology results.

The improved documentation and charge capture inevitably supported hospital revenue growth, as did MedWest’s ability to accommodate a 15 percent increase in patient volume as a result of improving throughput. In fact, Haywood increased its revenue 9.5 percent, a net increase exceeding $3 million from 2011 to 2012. Patient flow strategies that incorporate ED automation can have a powerful impact on the hospital.

As hospital administrators grapple with overcrowding, tightened budgets and numerous other regulatory challenges, improved throughput can help increase capacity, capturing lost revenue and reducing risk. The data provided by an EDIS is critical in identifying opportunities for improvement and implementing process change.


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