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care program, the conversion to electronic records made sense.” Fortunately, the hospital ED found the organized e-chart an invaluable tool for meeting regulatory needs and collecting data points, performance indicators and metrics. “There is so much data that can be pulled to improve care and also to compare performance,” says Turzer-Commesso. Thorough electronic documentation is helping to easily monitor many time intervals, such as door-to-room time and room-to-doctor time. These throughput metrics can assist in identifying areas for improvement and individual performance

Caregivers now travel with mobile computer carts room to room, documenting care and entering orders at the patient’s bedside. Bedside computers were also installed in all ED patient treatment rooms (excluding the psychiatric room and hallway beds), which increased clinicians’ access to real- time data. Since the EDIS’ patient tracking and status board can be viewed from any computer, this new feature helped nurses and staff communicate about a patient’s care more quickly and easily.

“Since we are markedly challenged by space, our EDIS has dramatically impacted our awareness of patient flow,” says Carrico, explaining the real-time ED data depicts inflow, throughput and departmental outflow. “The ED director reviews this data numerous times throughout the day and even while off duty to predict and manage staffing needs.”

Dosher Memorial Hospital Approximately one mile from Cape Fear, Dosher Memorial Hospital is located in the coastal historic town of Southport, N.C., in Brunswick County. With 25 staffed beds and 64 licensed skilled nursing center beds, the critical access community hospital converted its emergent care paper-based charting to electronic documentation in April 2011. It wanted to qualify for meaningful- use funds, optimize patient care and improve workflow, care coordination and communication.

“The hospital tried multiple times to create electronic forms for nurses, but the project was eventually dropped due to the difficulty reading printed forms, clinician resistance to utilization and a perceptible increase in flow issues,” says JoAnn Turzer-Commesso, R.N., MSN, director of emergency services, Dosher Memorial Hospital. “As patient safety questions escalated with the need to convert to CPOE and a well-integrated HEALTH MANAGEMENT TECHNOLOGY December 2012 7

metrics. One such metric was a decrease in patients foregoing care from 2.45 to 2.18 percent.

Dosher Memorial credits the EDIS for supporting new ED physician and nursing workflow changes that are also influencing process improvements, such as stronger clinician- staff alignment. “Flow processes are definitely improved,” says Turzer-Commesso. “Everyone knows what is going on throughout the entire department, including the triage and waiting room areas. This instant knowledge helps prepare us for incoming patients.” Moreover, the hospital ED’s work efficiencies and patient safety efforts are benefiting from the EDIS’ computerized provider order entry (CPOE) and patient tracking board functions. “By having CPOE, the staff has found it easier to read and verify orders,” Turzer-Commesso says. “There is more unification with everyone on the same page.”

MedWest Health System MedWest Health System serves 160,000 people in western North Carolina, providing quality healthcare in Haywood, Jackson, Swain, Macon and Graham counties. Affiliated with Carolinas HealthCare, the organization employs more than

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