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ER/ICU Management On the front lines

How HIT accelerates ED success in supporting new healthcare models. By Will Freeman, M.D., MMM, FACEP, FAAEM


mergency departments (EDs) are increasingly being seen as the hospital’s front door, with more than half of all hospitalizations beginning in the ED. Emergency departments now serve as the main source of healthcare for a growing segment of the U.S. popu- lation that lacks adequate access to primary care services for a variety of reasons, including inability to pay for healthcare costs, lack of insurance, physician shortages and working households that need after-hour services.

This high rate of use has led to resources being stretched thin and an increased impact from inefficiencies in hospital processes and flow. Many EDs are overcrowded. According to a report in the Annals of Emergency Medicine, the aver- age waiting time for patients to see a physician in the ED is 37 minutes, well above the recommended maximum of 15 minutes (Ann Emerg Med. 2010 Feb.; 55(2): 133-141). Moreover, much of the backlog of patient flow isn’t neces- sarily related to ED problems, but instead caused by systemic issues that delay moving patients from the ED to inpatient floors. These in-house delays drive up ED wait times and lead to more patients leaving without being seen (LWBS) by a phy- sician. The sheer volume of patients means more diagnostic work is being done in the ED, and inefficient or inadequately staffed ancillary systems result in prolonging stays. To combat these issues are the new value-based initiatives and performance incentives, which effectively promote col- laborative care for better patient outcomes. Once regarded almost as “entities unto themselves,” EDs are increasingly recognized as partners along the healthcare continuum – partners that can significantly impact access, quality and cost. The advent of models, such as the patient-centered medical home, accountable care organizations and evolving regulations regarding meaningful use and data sharing, means that information exchange between EDs and other providers – primary care physicians (PCPs), specialists, hospitals and ancillary care facilities – is critical.

Effective health information technology (HIT) has become integral to meeting these objectives and elevating healthcare delivery in any setting. EDs, in particular, are challenged when assessing and selecting electronic health record (EHR) systems because their workflow and treatment protocols differ from other providers. Their clinical decisions can also be significantly influenced by access to other patient data. Choosing an ED information system (EDIS) tailored to the specific needs of ED professionals improves patient safety, provides for coordinated care and allows for ongoing patient

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care management and monitoring of public health issues.

The opportunities for improv- ing patient safety in the digital ED abound. Enhancing com- munication among care team members, optimizing department workflow and ensuring appropri- ate reimbursement are just a few examples. The EDIS also helps

Will Freeman, M.D., is associate program director at the Louisiana State University (LSU) Earl K. Long Emergency Medicine Residency Program and CMO for C&M Medical Services. For more on C&M Medical Services: www.rsleads. com/212ht-206

with meaningful-use attestation by meeting multiple mea- surement standards, including problem lists, physician order entry, active medication lists, quality measure reporting and medication reconciliation compliance.

In an ED setting, maintaining the proper documentation and efficient flow of information can be difficult when trau- mas, severe illnesses and other medical emergencies fill the department beyond capacity. An EDIS provides real-time data on volume, acuity, wait time and length of stay. Armed with this data, leaders can adjust clinical and operational processes to streamline workflows and improve patient safety. The system also can help reduce the time patients wait to be seen. Reducing wait time decreases the number of LWBS, which boosts patient satisfaction. The EDIS also helps im- prove admissions, ensuring that patients are placed in the most appropriate hospital unit, and accelerates discharges. The most advanced EDIS technologies are also creating a safer environment for patients by providing physicians and nurses with vital data, such as drug and allergy interaction alerts, laboratory and radiological tests results, and best practices information to help these individuals make better clinical decisions at the point of care. The end result for the ED is a seamless flow of patient data enabled by software that does not interfere with clinicians’ patient care. An EDIS helps improve patient care by allowing EDs, hospitals and PCPs to share information. Coordination of care can occur in the ED through accessing information from previous visits, sharing information from the ED visit with the primary care physician and accessing information from other hospitals with similar systems. Sharing information from other sources enables the ED physician to better care for the patient by reducing the need for unnecessary testing or repeating tests already performed. Cutting redundant tests saves patients and payers money.

In addition to facilitation information sharing, an EDIS improves patient care through the use of an electronic record.


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