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Faris N, Saliba M, Tamim H, Jabbour R, Fakih A, Sadek Z, Antoun R, El Sayed M, Hitti E. Electronic medical record implementation in the emergency department in a low-resource country: Lessons learned. PLoS One 2024; 19:e0298027. [PMID: 38427653 PMCID: PMC10906867 DOI: 10.1371/journal.pone.0298027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/17/2024] [Indexed: 03/03/2024] Open
Abstract
OBJECTIVE There is paucity of information regarding electronic medical record (EMR) implementation in emergency departments in countries outside the United States especially in low-resource settings. The objective of this study is to describe strategies for a successful implementation of an EMR in the emergency department and to examine the impact of this implementation on the department's operations and patient-related metrics. METHODS We performed an observational retrospective study at the emergency department of a tertiary care center in Beirut, Lebanon. We assessed the effect of EMR implementation by tracking emergency departments' quality metrics during a one-year baseline period and one year after implementation. End-user satisfaction and patient satisfaction were also assessed. RESULTS Our evaluation of the implementation of EMR in a low resource setting showed a transient increase in LOS and visit-to-admission decision, however this returned to baseline after around 6 months. The bounce-back rate also increased. End-users were satisfied with the new EMR and patient satisfaction did not show a significant change. CONCLUSIONS Lessons learned from this successful EMR implementation include a mix of strategies recommended by the EMR vendor as well as specific strategies used at our institution. These can be used in future implementation projects in low-resource settings to avoid disruption of workflows.
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Affiliation(s)
- Nagham Faris
- Emergency Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Miriam Saliba
- Emergency Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Rima Jabbour
- Emergency Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ahmad Fakih
- Department of Information Technology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Zouhair Sadek
- Department of Information Technology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rula Antoun
- Department of Information Technology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mazen El Sayed
- Emergency Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Eveline Hitti
- Emergency Department, American University of Beirut Medical Center, Beirut, Lebanon
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Cheung K, Yip CS. Documentation Completeness and Nurses' Perceptions of a Novel Electronic App for Medical Resuscitation in the Emergency Room: Mixed Methods Approach. JMIR Mhealth Uhealth 2024; 12:e46744. [PMID: 38180801 PMCID: PMC10799286 DOI: 10.2196/46744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 09/19/2023] [Accepted: 11/29/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Complete documentation of critical care events in the accident and emergency department (AED) is essential. Due to the fast-paced and complex nature of resuscitation cases, missing data is a common issue during emergency situations. OBJECTIVE This study aimed to evaluate the impact of a tablet-based resuscitation record on documentation completeness during medical resuscitations and nurses' perceptions of the use of the tablet app. METHODS A mixed methods approach was adopted. To collect quantitative data, randomized retrospective reviews of paper-based resuscitation records before implementation of the tablet (Pre-App Paper; n=176), paper-based resuscitation records after implementation of the tablet (Post-App Paper; n=176), and electronic tablet-based resuscitation records (Post-App Electronic; n=176) using a documentation completeness checklist were conducted. The checklist was validated by 4 experts in the emergency medicine field. The content validity index (CVI) was calculated using the scale CVI (S-CVI). The universal agreement S-CVI was 0.822, and the average S-CVI was 0.939. The checklist consisted of the following 5 domains: basic information, vital signs, procedures, investigations, and medications. To collect qualitative data, nurses' perceptions of the app for electronic resuscitation documentation were obtained using individual interviews. Reporting of the qualitative data was guided by Consolidated Criteria for Reporting Qualitative Studies (COREQ) to enhance rigor. RESULTS A significantly higher documentation rate in all 5 domains (ie, basic information, vital signs, procedures, investigations, and medications) was present with Post-App Electronic than with Post-App Paper, but there were no significant differences in the 5 domains between Pre-App Paper and Post-App Paper. The qualitative analysis resulted in main categories of "advantages of tablet-based documentation of resuscitation records," "challenges with tablet-based documentation of resuscitation records," and "areas for improvement of tablet-based resuscitation records." CONCLUSIONS This study demonstrated that higher documentation completion rates are achieved with electronic tablet-based resuscitation records than with traditional paper records. During the transition period, the nurse documenters faced general problems with resuscitation documentation such as multitasking and unique challenges such as software updates and a need to familiarize themselves with the app's layout. Automation should be considered during future app development to improve documentation and redistribute more time for patient care. Nurses should continue to provide feedback on the app's usability and functionality during app refinement to ensure a successful transition and future development of electronic documentation records.
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Affiliation(s)
- Kin Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Chak Sum Yip
- Accident and Emergency Department, Tuen Mun Hospital, Hong Kong, China (Hong Kong)
- Quality & Safety Office, The Hong Kong Children's Hospital, Hong Kong, China (Hong Kong)
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Mattay GS, Griffey RT, Narra V, Poirier RF, Bierhals A. Impact of Predictive Text Clinical Decision Support on Imaging Order Entry in the Emergency Department. J Am Coll Radiol 2023; 20:1250-1257. [PMID: 37805010 DOI: 10.1016/j.jacr.2023.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/03/2023] [Accepted: 05/09/2023] [Indexed: 10/09/2023]
Abstract
PURPOSE Imaging clinical decision support (CDS) is designed to assist providers in selecting appropriate imaging studies and is now federally required. The aim of this study was to understand the effect of CDS on decisions and workflows in the emergency department (ED). METHODS The authors' institution's order entry platform serves up structured indications for imaging orders. Imaging orders are scored by CDS on the basis of appropriate use criteria (AUC). CDS triggers alerts for imaging orders with low AUC scores. Because free text alone cannot be scored by CDS, an artificial intelligence predictive text (AIPT) module was implemented to guide the selection of structured indications when free-text indications are entered. A total of 17,355 imaging orders in the ED over 6 months were retrospectively analyzed. RESULTS CDS alerts for low AUC scores were triggered for 3% of all imaging study orders (522 of 17,355). Providers spent an average of 24 seconds interacting with alerts. In 18 of 522 imaging orders with alerts, alternative studies were ordered. After AIPT implementation, the percentage of unscored studies significantly decreased from 81% to 45% (P < .001). CONCLUSIONS In a quaternary academic ED, CDS alerts triggered by low AUC scores caused minimal increase in time spent on imaging order entry but had a relatively marginal impact on imaging study selection. AIPT implementation increased the number of scored studies and could potentially enhance CDS effects. CDS implementation enables the collection of novel data regarding which imaging studies receive low AUC scores. Future work could include exploring alternative models of CDS implementation to maximize its impact.
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Affiliation(s)
- Govind S Mattay
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri.
| | - Richard T Griffey
- Associate Chief, Emergency Medicine, Department of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Vamsi Narra
- Senior Vice Chair, Imaging Informatics and New Business Development, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri; Chief, Radiology, Barnes-Jewish West County Hospital, St. Louis, Missouri; Associate Chief Medical Informatics Officer, BJC HealthCare, St. Louis, Missouri
| | - Robert F Poirier
- Associate Chief, Emergency Medicine, Department of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri; Medical Director and Chief of Clinical Operations, Emergency Medicine, Barnes-Jewish Hospital, St. Louis, Missouri
| | - Andrew Bierhals
- Vice Chair, Community Radiology, Vice Chair, Quality and Safety, Medical and Director for CT, Center for Clinical Imaging Research, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri; Director of Cardiothoracic Imaging, Barnes-Jewish West County Hospital, St. Louis, Missouri. https://twitter.com/AMdmph
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Yoo HH, Ro YS, Ko E, Lee JH, Han SH, Kim T, Shin TG, Kim S, Chang H. Epidemiologic trends of patients who visited nationwide emergency departments: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018-2022. Clin Exp Emerg Med 2023; 10:S1-S12. [PMID: 37967858 PMCID: PMC10662522 DOI: 10.15441/ceem.23.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 10/17/2023] [Indexed: 11/17/2023] Open
Abstract
OBJECTIVE : This study analyzed trends in emergency department (ED) visits in South Korea using the National Emergency Department Information System (NEDIS) data from 2018 to 2022. METHODS : This was a retrospective observational study using data from the NEDIS database from 2018 to 2022. Age- and sex-standardized ED visits per 100,000 population, as well as age- and sex-standardized rates for mortality, admission, and transfer, were calculated. RESULTS : The standardized ED visits per 100,000 population was approximately 20,000 from 2018 to 2019 and decreased to about 18,000 in 2022. The standardized mortality rate ranged from 1.4% to 1.7%. The admission rate (18.4%-19.4%) and the transfer rates (1.6%-1.8%) were similar during the study period. Approximately 5.5% of patients were triaged as Korean Triage and Acuity Scale score 1 or 2. About 91% of patients visited the ED directly and 21.7% of patients visited the ED with an ambulance. The ED length of stay was less than 6 hours in 90.3% of patients and the ED mortality rate was 0.6%. Acute gastroenteritis was the most common diagnosis. Respiratory virus symptoms, such as fever and sore throat, were also common chief complaints. CONCLUSION : ED visits decreased during the 5-year period, while admission, transfer, and death rates remained relatively stable.
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Affiliation(s)
- Hyun Ho Yoo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Sun Ro
- National Emergency Medical Center, National Medical Center, Seoul, Korea
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Eunsil Ko
- National Emergency Medical Center, National Medical Center, Seoul, Korea
| | - Jin-Hee Lee
- National Emergency Medical Center, National Medical Center, Seoul, Korea
| | - So-hyun Han
- National Emergency Medical Center, National Medical Center, Seoul, Korea
| | - Taerim Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seongjung Kim
- National Emergency Medical Center, National Medical Center, Seoul, Korea
- Department of Emergency Medicine, Chosun University Hospital, Gwangju, Korea
| | - Hansol Chang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Griffey RT, Schneider RM, Todorov AA. Near-Miss Events Detected Using the Emergency Department Trigger Tool. J Patient Saf 2023; 19:59-66. [PMID: 36715980 PMCID: PMC9974611 DOI: 10.1097/pts.0000000000001092] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Near misses include conditions with potential for harm, intercepted medical errors, and events requiring monitoring or intervention to prevent harm. Little is reported on near misses or their importance for quality and safety in the emergency department (ED). METHODS This is a secondary evaluation of data from a retrospective study of the ED Trigger Tool (EDTT) at an urban, academic ED (data from October 1, 2014, to October 31, 2015; 92,859 eligible visits). All patients 18 years and older completing a visit were eligible. We ran the EDTT, a computerized query for triggers on 13 months of ED visit data, reviewing 5582 selected records using a 2-tiered approach. Events were categorized by occurrence (ED vs present on arrival [POA]), severity, omission/commission, and type, using a taxonomy with categories, subcategories, and cross-cutting modifiers. RESULTS We identified 1458 ED near misses in 1269 of 5582 records (22.7%) and 80 near misses that were POA. Patient care events represented most ED near misses, including delays in diagnosis, treatment, and failure to monitor, primarily driven by ED boarding and crowding. Medication events were second most common (17%), including 80 medication administration errors. Of 80 POA events, 42% were related to overanticoagulation. We estimate that 19.3% of all ED visits include a near miss. CONCLUSIONS Near-miss events are relatively common (22.7% of our sample, 19.3% in the population) and are associated with an increased risk for an adverse event. Most events were patient care related (77%) involving delays due to crowding and ED boarding followed by medication administration errors. The EDTT is a high-yield approach for detecting important near misses and latent system deficiencies that impact patient safety.
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Affiliation(s)
- Richard T. Griffey
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis MO
| | - Ryan M. Schneider
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis MO
| | - Alexandre A. Todorov
- Department of Psychiatry, Washington University School of Medicine, St. Louis MO
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Fattahi M, Keyvanshokooh E, Kannan D, Govindan K. Resource planning strategies for healthcare systems during a pandemic. EUROPEAN JOURNAL OF OPERATIONAL RESEARCH 2023; 304:192-206. [PMID: 35068665 PMCID: PMC8759806 DOI: 10.1016/j.ejor.2022.01.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 01/10/2022] [Indexed: 05/14/2023]
Abstract
We study resource planning strategies, including the integrated healthcare resources' allocation and sharing as well as patients' transfer, to improve the response of health systems to massive increases in demand during epidemics and pandemics. Our study considers various types of patients and resources to provide access to patient care with minimum capacity extension. Adding new resources takes time that most patients don't have during pandemics. The number of patients requiring scarce healthcare resources is uncertain and dependent on the speed of the pandemic's transmission through a region. We develop a multi-stage stochastic program to optimize various strategies for planning limited and necessary healthcare resources. We simulate uncertain parameters by deploying an agent-based continuous-time stochastic model, and then capture the uncertainty by a forward scenario tree construction approach. Finally, we propose a data-driven rolling horizon procedure to facilitate decision-making in real-time, which mitigates some critical limitations of stochastic programming approaches and makes the resulting strategies implementable in practice. We use two different case studies related to COVID-19 to examine our optimization and simulation tools by extensive computational results. The results highlight these strategies can significantly improve patient access to care during pandemics; their significance will vary under different situations. Our methodology is not limited to the presented setting and can be employed in other service industries where urgent access matters.
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Affiliation(s)
- Mohammad Fattahi
- Newcastle Business School, Northumbria University, Newcastle Upon Tyne, United Kingdom
| | - Esmaeil Keyvanshokooh
- Department of Information & Operations Management, Mays Business School, Texas A&M University, College Station, TX 77845, USA
| | - Devika Kannan
- Center for Sustainable Supply Chain Engineering, Department of Technology and Innovation, Danish Institute for Advanced Study, University of Southern Denmark, Campusvej 55, Odense M, Denmark
| | - Kannan Govindan
- China Institute of FTZ Supply Chain, Shanghai Maritime University, Shanghai, 201306, China
- Yonsei Frontier Lab, Yonsei University, Seoul, South Korea
- Center for Sustainable Supply Chain Engineering, Department of Technology and Innovation, Danish Institute for Advanced Study, University of Southern Denmark, Campusvej 55, Odense M, Denmark
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Almasi S, Mehrabi N, Asadi F, Afzali M. Usability of Emergency Department Information System Based on Users' Viewpoint; a Cross-Sectional Study. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2022; 10:e71. [PMID: 36381966 PMCID: PMC9637262 DOI: 10.22037/aaem.v10i1.1635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION The emergency department is of special importance due to its emergency and vital services, the high volume of referrals, and the patients' physical condition. Thus, it requires a well-designed information system with no usability problems. This study aimed to evaluate the usability of the emergency department information system from users' perspectives. METHODS This was a cross-sectional study. The research setting was the emergency department of 3 hospitals. The research instrument was a 37-item questionnaire adapted from the USE and ISO Metrics questionnaires, consisting of five dimensions measuring the usefulness of the system, ease of use, ease of learning, user satisfaction, and suitability for the task. The content validity of the questionnaire was examined using the content validity ratio and content validity index, and its reliability was assessed using Cronbach's alpha (α = 0.88). RESULTS Fifty questionnaires were administered in the three hospitals, and the response rate was 80%. According to the findings, 55% of the respondents were female. The highest mean scores belonged to usefulness in emergency department information system (EDIS) A, ease of use in EDIS B, ease of learning in EDIS A, user satisfaction in EDIS C, and suitability for the task in EDIS A. According to the usability evaluation criteria, ease of learning (3.66 ± 0.74), usefulness (3.53 ± 0.87), and suitability for the task (3.47 ± 0.96) received the highest scores, and the lowest scores belonged to user satisfaction (3.29 ± 1.01) and ease of use (3.12 ± 1.00). CONCLUSION In terms of usability criteria, the emergency department information system is at a relatively good level. The usability of these systems can be further enhanced by considering the users' working needs, improving software flexibility, customizing the software, using data visualization tools, observing consistency of features and standards, and increasing the quality of information and system services.
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Affiliation(s)
- Sohrab Almasi
- Department of Health Information Technology, School of Paramedical Sciences, AJA University of Medical Sciences, Tehran, Iran
| | - Nahid Mehrabi
- Department of Health Information Technology, School of Paramedical Sciences, AJA University of Medical Sciences, Tehran, Iran.,Corresponding author: Nahid Mehrabi; Department of Health Information Technology, Aja University of Medical Sciences, Tehran, Iran. Phone number: (+98) 21 43822453 , Fax: (+98) 21 8802 8364, , ORCID: https://orcid.org/0000-0003-2840-056X
| | - Farkhondeh Asadi
- Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahboobeh Afzali
- Department of Emergency Medicine, School of Paramedical Sciences, Aja University of Medical Sciences, Tehran, Iran
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Improving Communication with Patients Discharged from the Emergency Department with Noncardiac Chest Pain: A Scoping Review with Narrative Synthesis. Emerg Med Int 2021; 2021:6695210. [PMID: 34513092 PMCID: PMC8426084 DOI: 10.1155/2021/6695210] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 01/05/2023] Open
Abstract
Background This scoping review with narrative synthesis aimed to analyze scholarly peer-reviewed articles reporting on improving communication with patients discharged from the emergency department with noncardiac chest pain and qualitatively narrate on and summarize items that can be used in guiding communication with patients discharged from the emergency department with noncardiac chest pain. Methods The databases of EMBASE/PubMed, Scopus, COCHRANE, CInAHL/EBESCO, UW libraries, and Google Scholar were searched using relevant MeSH and key terms up to February 06, 2020. The selected articles were analyzed for their contents. Items guiding discharge communication were summarized qualitatively. Results Twenty-five articles were eligible for full review. These were published in between 1994 and 2020. Of those, 16 (64.0%) originated from the United States and 4 (16%) used some interventional design. A total of 45 different items that could be used in guiding discharge communication with patients presenting to the emergency department with chest pain were identified from the studies included in this review. Items were grouped under 6 categories that were related to initial assessment (8 items), information on diagnosis (7 items), information on discharge (9 items), follow-up suggestions (7 items), symptoms that promote return to the emergency department (7 items), and treatment plan (7 items). Conclusion Communication with patients discharged from the emergency department with noncardiac chest pain can be improved. Results of this investigation might be helpful in guiding quality improvement projects aimed for further improvement of communication with patients discharged from the emergency department with noncardiac chest pain.
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Tan AJ, Swartz J, Wilkins C, Grudzen C. Leveraging Emergency Department Information Systems to Address Palliative Care Needs of ED Patients During the COVID Pandemic. Am J Hosp Palliat Care 2021; 39:581-583. [PMID: 34463145 DOI: 10.1177/10499091211042854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The arrival of the COVID-19 pandemic to hospitals in New York City stressed our emergency departments (ED) with high patient volume, stresses on hospital resources and the arrival of numerous high acuity, critically ill patients. Amid this time, we sought to leverage the ED Information Systems (EDIS), to assist in connecting critically ill patients, their families, and providers in the ED with palliative care resources. We discuss 4 innovative, thoughtful solutions to assist ED providers in identifying and addressing the acute and unique palliative care needs of COVID patients.
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Affiliation(s)
- Audrey J Tan
- Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, New York, NY, USA.,Division of Geriatric Medicine and Palliative Care, Department of Medicine, NYU Langone Health, New York, NY, USA
| | - Jordan Swartz
- Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, New York, NY, USA
| | | | - Corita Grudzen
- Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, New York, NY, USA.,Department of Population Health, NYU School of Medicine, New York, NY, USA
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10
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Turer RW, Arribas M, Balgord SM, Brooks S, Hopson LR, Bassin BS, Medlin R. Clinical Informatics Training During Emergency Medicine Residency: The University of Michigan Experience. AEM EDUCATION AND TRAINING 2021; 5:e10518. [PMID: 34041427 PMCID: PMC8138099 DOI: 10.1002/aet2.10518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/30/2020] [Accepted: 08/08/2020] [Indexed: 06/12/2023]
Abstract
Clinical informatics (CI) is a rich field with longstanding ties to resident education in many clinical specialties, although a historic gap persists in emergency medicine. To address this gap, we developed a CI track to facilitate advanced training for senior residents at our 4-year emergency medicine residency. We piloted an affordable project-based approach with strong ties to operational leadership at our institution and describe specific projects and their outcomes. Given the relatively low cost, departmental benefit, and unique educational value, we believe that our model is generalizable to many emergency medicine residencies. We present a pathway to defining a formal curriculum using Kern's framework.
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Affiliation(s)
- Robert W. Turer
- Departments of Emergency Medicine and Biomedical InformaticsVanderbilt University Medical CenterNashvilleTNUSA
- Department of Emergency MedicineUniversity of MichiganAnn ArborMIUSA
| | - Miguel Arribas
- Department of Emergency MedicineUniversity of MichiganAnn ArborMIUSA
| | - Sarah M. Balgord
- Department of Emergency MedicineUniversity of MichiganAnn ArborMIUSA
| | - Stephanie Brooks
- Department of Emergency MedicineUniversity of MichiganAnn ArborMIUSA
| | - Laura R. Hopson
- Department of Emergency MedicineUniversity of MichiganAnn ArborMIUSA
| | - Benjamin S. Bassin
- Department of Emergency MedicineUniversity of MichiganAnn ArborMIUSA
- Michigan Center for Integrative Research in Critical Care (M‐CIRCC)Ann ArborMIUSA
- Department of Emergency MedicineDivision of Critical CareAnn ArborMIUSA
| | - Richard Medlin
- Department of Emergency MedicineUniversity of MichiganAnn ArborMIUSA
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Simon LE, Rauchwerger AS, Chettipally UK, Babakhanian L, Vinson DR, Warton EM, Reed ME, Kharbanda AB, Kharbanda EO, Ballard DW. Text message alerts to emergency physicians identifying potential study candidates increase clinical trial enrollment. J Am Med Inform Assoc 2021; 26:1360-1363. [PMID: 31340023 DOI: 10.1093/jamia/ocz118] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/05/2019] [Accepted: 06/11/2019] [Indexed: 12/25/2022] Open
Abstract
Prospective enrollment of research subjects in the fast-paced emergency department (ED) is challenging. We sought to develop a software application to increase real-time clinical trial enrollment during an ED visit. The Prospective Intelligence System for Clinical Emergency Services (PISCES) scans the electronic health record during ED encounters for preselected clinical characteristics of potentially eligible study participants and notifies the treating physician via mobile phone text alerts. PISCES alerts began 3 months into a cluster randomized trial of an electronic health record-based risk stratification tool for pediatric abdominal pain in 11 Northern California EDs. We compared aggregate enrollment before (2577 eligible patients, October 2016 to December 2016) and after (12 049 eligible patients, January 2017 to January 2018) PISCES implementation. Enrollment increased from 10.8% to 21.1% following PISCES implementations (P < .001). PISCES significantly increased study enrollment and can serve as a valuable tool to assist prospective research enrollment in the ED.
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Affiliation(s)
- Laura E Simon
- Division of Research, Kaiser Permanente, Oakland, California, USA
| | | | - Uli K Chettipally
- Emergency Department, Kaiser Permanente South San Francisco Medical Center, South San Francisco, California, USA
| | | | - David R Vinson
- Division of Research, Kaiser Permanente, Oakland, California, USA.,Emergency Department, Kaiser Permanente Roseville Medical Center, Roseville, California, USA
| | | | - Mary E Reed
- Division of Research, Kaiser Permanente, Oakland, California, USA
| | - Anupam B Kharbanda
- Emergency Department, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, USA
| | - Elyse O Kharbanda
- Division of Research, HealthPartners Institute, Minneapolis, Minnesota, USA
| | - Dustin W Ballard
- Division of Research, Kaiser Permanente, Oakland, California, USA.,Emergency Department, Kaiser Permanente San Rafael Medical Center, San Rafael, California, USA
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12
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Todd B, Shinthia N, Nierenberg L, Mansour L, Miller M, Otero R. Impact of Electronic Medical Record Alerts on Emergency Physician Workflow and Medical Management. J Emerg Med 2020; 60:390-395. [PMID: 33298357 DOI: 10.1016/j.jemermed.2020.10.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/28/2020] [Accepted: 10/04/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Electronic medical record (EMR) alerts are automated messages that notify the physician of important information. However, little is known about how EMR alerts affect the workflow and decision-making of emergency physicians (EPs). STUDY OBJECTIVES This study aimed to quantify the number of EMR alerts EPs receive, the time required to resolve alerts, the types of alerts EPs receive, and the impact of alerts on patient management. METHODS We performed a prospective observational study at a tertiary care ED with 130,000 visits annually. Research assistants observed EPs on shift from May to December 2018. They recorded the number of EMR alerts received, time spent addressing the alerts, the types of alerts received, and queried the EP to determine if the alert impacted patient management. RESULTS Seven residents and six attending physicians were observed on a total of 17 shifts and 153 patient encounters; 78% (119) of patient encounters involved alerts. These 119 patients triggered 530 EMR alerts. EPs spent a mean of 7.06 s addressing each alert and addressed 3.46 alerts per total patient seen. In total, EPs spent approximately 24 s per patient resolving alerts. Only 12 alerts (2.26%) changed clinical management. CONCLUSION EPs frequently receive EMR alerts, however, most alerts were not perceived to impact patient care. These alerts contribute to the high volume of interruptions EPs must contend with in the clinical environment of the ED.
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Affiliation(s)
- Brett Todd
- Department of Emergency Medicine, Beaumont Health, Royal Oak, Michigan
| | - Nashid Shinthia
- Department of Emergency Medicine, Beaumont Health, Royal Oak, Michigan
| | | | | | | | - Ronny Otero
- Department of Emergency Medicine, Beaumont Health, Royal Oak, Michigan
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13
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Goto T, Hara K, Hashimoto K, Soeno S, Shirakawa T, Sonoo T, Nakamura K. Validation of chief complaints, medical history, medications, and physician diagnoses structured with an integrated emergency department information system in Japan: the Next Stage ER system. Acute Med Surg 2020; 7:e554. [PMID: 32884825 PMCID: PMC7453131 DOI: 10.1002/ams2.554] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 01/11/2023] Open
Abstract
Aim Emergency department information systems (EDIS) facilitate free‐text data use for clinical research; however, no study has validated whether the Next Stage ER system (NSER), an EDIS used in Japan, accurately translates electronic medical records (EMRs) into structured data. Methods This is a retrospective cohort study using data from the emergency department (ED) of a tertiary care hospital from 2018 to 2019. We used EMRs of 500 random samples from 27,000 ED visits during the study period. Through the NSER system, chief complaints were translated into 231 chief complaint categories based on the Japan Triage and Acuity Scale. Medical history and physician’s diagnoses were encoded using the International Classification of Diseases, 10th Revision; medications were encoded as Anatomical Therapeutic Chemical Classification System codes. Two reviewers independently reviewed 20 items (e.g., presence of fever) for each study component (e.g., chief complaints). We calculated association measures of the structured data by the NSER system, using the chart review results as the gold standard. Results Sensitivities were very high (>90%) in 17 chief complaints. Positive predictive values were high for 14 chief complaints (≥80%). Negative predictive values were ≥96% for all chief complaints. For medical history and medications, most of the association measures were very high (>90%). For physicians’ ED diagnoses, sensitivities were very high (>93%) in 16 diagnoses; specificities and negative predictive values were very high (>97%). Conclusions Chief complaints, medical history, medications, and physician’s ED diagnoses in EMRs were well‐translated into existing categories or coding by the NSER system.
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Affiliation(s)
- Tadahiro Goto
- Department of Clinical Epidemiology and Health EconomicsSchool of Public HealthThe University of TokyoTokyoJapan
- TXP Medical Co. LtdTokyoJapan
| | - Konan Hara
- TXP Medical Co. LtdTokyoJapan
- Department of Public HealthGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Katsuhiko Hashimoto
- Department of Emergency MedicineSouthern Tohoku General HospitalKoriyamaJapan
| | - Shoko Soeno
- TXP Medical Co. LtdTokyoJapan
- Department of Emergency MedicineSouthern Tohoku General HospitalKoriyamaJapan
| | - Toru Shirakawa
- TXP Medical Co. LtdTokyoJapan
- Department of Social MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Tomohiro Sonoo
- TXP Medical Co. LtdTokyoJapan
- Department of Emergency MedicineHitachi General HospitalHitachiJapan
| | - Kensuke Nakamura
- Department of Emergency MedicineHitachi General HospitalHitachiJapan
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14
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Abstract
Information management in the emergency department (ED) is a challenge for all providers. The volume of information required to care for each patient and to keep the ED functioning is immense. It must be managed through varying means of communication and in connection with ED information systems. Management of information in the ED is imperfect; different modes and methods of identification, interpretation, action, and communication can be beneficial or harmful to providers, patients, and departmental flow. This article reviews the state of information management in the ED and proposes recommendations to improve the management of information in the future.
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Affiliation(s)
- Evan L Leventhal
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Road, Boston, MA 02215, USA.
| | - Kraftin E Schreyer
- Department of Emergency Medicine, Temple University Hospital, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA
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15
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Fortman E, Hettinger AZ, Howe JL, Fong A, Pruitt Z, Miller K, Ratwani RM. Varying rates of patient identity verification when using computerized provider order entry. J Am Med Inform Assoc 2020; 27:924-928. [PMID: 32377679 DOI: 10.1093/jamia/ocaa047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/19/2020] [Accepted: 03/31/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE We sought to determine rates of computerized provider order entry (CPOE) patient identity verification and when and where in the ordering process verification occurred. MATERIALS AND METHODS Fifty-five physicians from 4 healthcare systems completed simulated patient scenarios using their respective CPOE system (Epic or Cerner). Eye movements were recorded and analyzed. RESULTS Across all participants patient id was verified significantly more often than not (62.4% vs 37.6%). Vendor A had significantly higher verification rates than not; vendor B had no difference. Participants using vendor A verified information significantly more often before signing the order than after (88.4% vs 11.6%); there was no difference in vendor B. The banner bar was the most frequent verification location. DISCUSSION Factors such as CPOE design, physician training, and the use of a simulated methodology may be impacting verification rates. CONCLUSIONS Verification rates vary by CPOE product, and this can have patient safety consequences.
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Affiliation(s)
- Emilie Fortman
- Georgetown University School of Medicine, Washington, DC, USA
| | - A Zachary Hettinger
- Georgetown University School of Medicine, Washington, DC, USA.,MedStar Health National Center for Human Factors in Healthcare, Washington, DC, USA
| | - Jessica L Howe
- MedStar Health National Center for Human Factors in Healthcare, Washington, DC, USA
| | - Allan Fong
- MedStar Health National Center for Human Factors in Healthcare, Washington, DC, USA
| | - Zoe Pruitt
- MedStar Health National Center for Human Factors in Healthcare, Washington, DC, USA
| | - Kristen Miller
- Georgetown University School of Medicine, Washington, DC, USA.,MedStar Health National Center for Human Factors in Healthcare, Washington, DC, USA
| | - Raj M Ratwani
- Georgetown University School of Medicine, Washington, DC, USA.,MedStar Health National Center for Human Factors in Healthcare, Washington, DC, USA
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16
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Sieck CJ, Pearl N, Bright TJ, Yen PY. A qualitative study of physician perspectives on adaptation to electronic health records. BMC Med Inform Decis Mak 2020; 20:25. [PMID: 32039728 PMCID: PMC7008538 DOI: 10.1186/s12911-020-1030-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 01/20/2020] [Indexed: 11/25/2022] Open
Abstract
Background Electronic Health Records (EHRs) have the potential to improve many aspects of care and their use has increased in the last decade. Because of this, acceptance and adoption of EHRs is less of a concern than adaptation to use. To understand this issue more deeply, we conducted a qualitative study of physician perspectives on EHR use to identify factors that facilitate adaptation. Methods We conducted semi-structured interviews with 9 physicians across a range of inpatient disciplines at a large Academic Medical Center. Interviews were conducted by phone, lasting approximately 30 min, and were transcribed verbatim for analysis. We utilized inductive and deductive methods in our analysis. Results We identified 4 major themes related to EHR adaptation: impact of EHR changes on physicians, how physicians managed these changes, factors that facilitated adaptation to using the EHR and adapting to using the EHR in the patient encounter. Within these themes, physicians felt that a positive mindset toward change, providing upgrade training that was tailored to their role, and the opportunity to learn from colleagues were important facilitators of adaptation. Conclusions As EHR use moves beyond implementation, physicians continue to be required to adapt to the technology and to its frequent changes. Our study provides actionable findings that allow healthcare systems to focus on factors that facilitate the adaptation process for physicians.
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Affiliation(s)
- Cynthia J Sieck
- Department of Family Medicine, The Ohio State University College of Medicine, Columbus, OH, 43201, USA. .,The Center for the Advancement of Team Science, Analytics, and Systems Thinking, Columbus, OH, USA.
| | - Nicole Pearl
- Institute for Informatics, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Po-Yin Yen
- Institute for Informatics, Washington University School of Medicine, St. Louis, MO, USA.,Goldfarb School of Nursing, Barnes-Jewish College, St. Louis, MO, USA
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17
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Su CT. Limiting the Number of Open Records in an Electronic Health Record. JAMA 2019; 322:1313-1314. [PMID: 31573631 DOI: 10.1001/jama.2019.11493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Christopher T Su
- Department of Medicine, University of Michigan Medical Center, Ann Arbor
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18
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Wang X, Kim TC, Hegde S, Hoffman DJ, Benda NC, Franklin ES, Lavergne D, Perry SJ, Fairbanks RJ, Hettinger AZ, Roth EM, Bisantz AM. Design and Evaluation of an Integrated, Patient-Focused Electronic Health Record Display for Emergency Medicine. Appl Clin Inform 2019; 10:693-706. [PMID: 31533171 PMCID: PMC6751068 DOI: 10.1055/s-0039-1695800] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 07/12/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Hospital emergency departments (EDs) are dynamic environments, involving coordination and shared decision making by staff who care for multiple patients simultaneously. While computerized information systems have been widely adopted in such clinical environments, serious issues have been raised related to their usability and effectiveness. In particular, there is a need to support clinicians to communicate and maintain awareness of a patient's health status, and progress through the ED plan of care. OBJECTIVE This study used work-centered usability methods to evaluate an integrated patient-focused status display designed to support ED clinicians' communication and situation awareness regarding a patient's health status and progress through their ED plan of care. The display design was informed by previous studies we conducted examining the information and cognitive support requirements of ED providers and nurses. METHODS ED nurse and provider participants were presented various scenarios requiring patient-prioritization and care-planning tasks to be performed using the prototype display. Participants rated the display in terms of its cognitive support, usability, and usefulness. Participants' performance on the various tasks, and their feedback on the display design and utility, was analyzed. RESULTS Participants provided ratings for usability and usefulness for the display sections using a work-centered usability questionnaire-mean scores for nurses and providers were 7.56 and 6.6 (1 being lowest and 9 being highest), respectively. General usability scores, based on the System Usability Scale tool, were rated as acceptable or marginally acceptable. Similarly, participants also rated the display highly in terms of support for specific cognitive objectives. CONCLUSION A novel patient-focused status display for emergency medicine was evaluated via a simulation-based study in terms of work-centered usability and usefulness. Participants' subjective ratings of usability, usefulness, and support for cognitive objectives were encouraging. These findings, including participants' qualitative feedback, provided insights for improving the design of the display.
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Affiliation(s)
- Xiaomei Wang
- Department of Industrial and Systems Engineering, University at Buffalo, State University of New York, Buffalo, New York, United States
| | - Tracy C. Kim
- National Center for Human Factors in Healthcare, MedStar Institute for Innovation, MedStar Health, Washington, District of Columbia, United States
| | - Sudeep Hegde
- Department of Industrial and Systems Engineering, University at Buffalo, State University of New York, Buffalo, New York, United States
| | - Daniel J. Hoffman
- National Center for Human Factors in Healthcare, MedStar Institute for Innovation, MedStar Health, Washington, District of Columbia, United States
| | - Natalie C. Benda
- National Center for Human Factors in Healthcare, MedStar Institute for Innovation, MedStar Health, Washington, District of Columbia, United States
| | - Ella S. Franklin
- National Center for Human Factors in Healthcare, MedStar Institute for Innovation, MedStar Health, Washington, District of Columbia, United States
| | - David Lavergne
- Smart Information Flow Technologies, Minneapolis, Minnesota, United States
| | - Shawna J. Perry
- Department of Emergency Medicine, University of Florida, Jacksonville, Florida, United States
| | - Rollin J. Fairbanks
- National Center for Human Factors in Healthcare, MedStar Institute for Innovation, MedStar Health, Washington, District of Columbia, United States
| | - A. Zachary Hettinger
- National Center for Human Factors in Healthcare, MedStar Institute for Innovation, MedStar Health, Washington, District of Columbia, United States
| | - Emilie M. Roth
- Roth Cognitive Engineering, Stanford, California, United States
| | - Ann M. Bisantz
- Department of Industrial and Systems Engineering, University at Buffalo, State University of New York, Buffalo, New York, United States
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19
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Brown N, Eghdam A, Koch S. Usability Evaluation of Visual Representation Formats for Emergency Department Records. Appl Clin Inform 2019; 10:454-470. [PMID: 31242513 PMCID: PMC6594835 DOI: 10.1055/s-0039-1692400] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Integration of electronic information is a challenge for multitasking emergency providers, with implications for patient safety. Visual representations can assist sense-making of complex data sets; however, benefit and acceptability in emergency care is unproven. OBJECTIVES This article evaluates visually focused alternatives to lists or tabular formats, to better understand possible usability in Emergency Department Information System (EDIS). METHODS A counterbalanced, repeated-measures experiment, satisfaction surveys, and narrative content analysis was conducted remotely by Web platform. Participants were 37 American emergency physicians; they completed 16 clinical cases comparing 4 visual designs to the control formats from a commercially available EDIS. They then evaluated two additional chart overview representations without controls. RESULTS Visual designs provided benefit in several areas compared to controls. Task correctness (90% to 76%; p = 0.003) and completion time (median: 49-74 seconds; p < 0.001) were superior for a medication history timeline with class and schedule highlighting. Completion time (median: 45-60 seconds; p = 0.03) was superior for a past medical history design, using pertinent diagnosis codes in highlighting rules. Less mental effort was reported for visual allergy (p = 0.04), past medical history (p < 0.001), and medication timeline (p < 0.001) designs. Most of the participants agreed with statements of likeability, preference, and benefit for visual designs; nonetheless, contrary opinions were seen, and more complex designs were viewed less favorably. CONCLUSION Physician performance with visual representations of clinical data can in some cases exceed standard formats, even in absence of training. Highlighting of priority clinical categories was rated easier-to-use on average than unhighlighted controls. Perceived complexity of timeline representations can limit desirability for a subset of users, despite potential benefit.
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Affiliation(s)
- Nathaniel Brown
- Department of Learning, Informatics, Management and Ethics, Health Informatics Centre, Karolinska Institutet, Stockholm, Sweden.,Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Aboozar Eghdam
- Department of Learning, Informatics, Management and Ethics, Health Informatics Centre, Karolinska Institutet, Stockholm, Sweden
| | - Sabine Koch
- Department of Learning, Informatics, Management and Ethics, Health Informatics Centre, Karolinska Institutet, Stockholm, Sweden
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20
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Driver BE, Scharber SK, Fagerstrom ET, Klein LR, Cole JB, Dhaliwal RS. The Effect of a Clinical Decision Support for Pending Laboratory Results at Emergency Department Discharge. J Emerg Med 2019; 56:109-113. [PMID: 30472015 DOI: 10.1016/j.jemermed.2018.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 10/01/2018] [Accepted: 10/07/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Health care systems often implement changes within the electronic health record (EHR) to improve patient safety and reduce medical errors. OBJECTIVE To compare the proportion of emergency department (ED) encounters with laboratory tests resulting subsequent to patient discharge before and after a clinical decision support was implemented. METHODS In 2015, our institution added an EHR dialogue when placing ED discharge orders, requiring providers to declare whether all laboratory results had been reviewed. To determine the effectiveness of this initiative, we searched the EHR to identify the proportion of ED encounters with laboratory tests resulting after discharge in pre- (January to June 2015) and post-intervention (January to June 2016) periods. RESULTS There were 67,287 discharged patients during the study periods. In the pre- and post-intervention periods, respectively, 6.9% (95% confidence interval [CI] 6.7-7.2%) and 7.9% (95% CI 7.6-8.2%) of encounters had laboratory tests resulting after discharge, with an absolute difference of 0.9% (95% CI 0.5-1.3%). Of these patients with laboratory tests resulting after ED discharge, in 92% the provider inaccurately marked "yes" or "not applicable" to the EHR dialogue prompt. CONCLUSIONS This workflow intervention was associated with an increase in the proportion of laboratory tests resulting after ED discharge; inaccurate answers to the EHR dialogue were pervasive. EHR workflow interventions do not always accomplish their intended goals, and their implementation should be considered thoughtfully.
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Affiliation(s)
- Brian E Driver
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
| | | | - Erik T Fagerstrom
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Lauren R Klein
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Jon B Cole
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Ramnik S Dhaliwal
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
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21
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Crawford S, Kushner I, Wells R, Monks S. Electronic Health Record Documentation Times among Emergency Medicine Trainees. PERSPECTIVES IN HEALTH INFORMATION MANAGEMENT 2019; 16:1f. [PMID: 30766457 PMCID: PMC6341413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Physicians spend a large portion of their time documenting patient encounters using electronic health records (EHRs). Meaningful Use guidelines have made EHR systems widespread, but they have not been shown to save time. This study compared the time required to complete an emergency department note in two different EHR systems for three separate video-recorded standardized simulated patient encounters. The total time needed to complete documentation, including the time to write and order the initial history, physical exam, and diagnostic studies, and the time to provide medical decision making and disposition, were recorded and compared by trainee across training levels. The only significant difference in documentation time was by classification, with second- and third-year trainees being significantly faster in documenting on the Cerner system than fourth-year medical student and first-year trainees (F = 8.36, p < .001). Level of training and experience with a system affected documentation time.
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Affiliation(s)
- Scott Crawford
- Texas Tech University Health Sciences Center El Paso in El Paso, TX
| | | | - Radosveta Wells
- Texas Tech University Health Sciences Center El Paso in El Paso, TX
| | - Stormy Monks
- Texas Tech University Health Sciences Center El Paso in El Paso, TX
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22
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Al Ghalayini M, Antoun J, Moacdieh NM. Too much or too little? Investigating the usability of high and low data displays of the same electronic medical record. Health Informatics J 2018; 26:88-103. [PMID: 30501370 DOI: 10.1177/1460458218813725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The high data density on electronic medical record screens is touted as a major usability issue. However, it may not be a problem if the data is relevant and well-organized. Our objective was to test this assumption using a comprehensive set of measures that assess the three pillars of usability: efficiency (both physical and cognitive), effectiveness, and satisfaction. Physicians were asked to go through a series of tasks using two versions of the same electronic medical record: one where all the display items were separated into tabs (the original display), and one where important display items were grouped logically in one tab (the redesigned display). Results supported the hypothesis that combining relevant data in organized fashion into a smaller location would improve usability. The findings highlight the role of good display organization to mitigate the effects of high data density, as well as the importance of assessing cognitive load as part of usability studies.
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23
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King K, Quarles J, Ravi V, Chowdhury TI, Friday D, Sisson C, Feng Y. The Impact of a Location-Sensing Electronic Health Record on Clinician Efficiency and Accuracy: A Pilot Simulation Study. Appl Clin Inform 2018; 9:841-848. [PMID: 30463095 DOI: 10.1055/s-0038-1675812] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Through the Health Information Technology for Economic and Clinical Health Act of 2009, the federal government invested $26 billion in electronic health records (EHRs) to improve physician performance and patient safety; however, these systems have not met expectations. One of the cited issues with EHRs is the human-computer interaction, as exhibited by the excessive number of interactions with the interface, which reduces clinician efficiency. In contrast, real-time location systems (RTLS)-technologies that can track the location of people and objects-have been shown to increase clinician efficiency. RTLS can improve patient flow in part through the optimization of patient verification activities. However, the data collected by RTLS have not been effectively applied to optimize interaction with EHR systems. OBJECTIVES We conducted a pilot study with the intention of improving the human-computer interaction of EHR systems by incorporating a RTLS. The aim of this study is to determine the impact of RTLS on process metrics (i.e., provider time, number of rooms searched to find a patient, and the number of interactions with the computer interface), and the outcome metric of patient identification accuracy METHODS: A pilot study was conducted in a simulated emergency department using a locally developed camera-based RTLS-equipped EHR that detected the proximity of subjects to simulated patients and displayed patient information when subjects entered the exam rooms. Ten volunteers participated in 10 patient encounters with the RTLS activated (RTLS-A) and then deactivated (RTLS-D). Each volunteer was monitored and actions recorded by trained observers. We sought a 50% improvement in time to locate patients, number of rooms searched to locate patients, and the number of mouse clicks necessary to perform those tasks. RESULTS The time required to locate patients (RTLS-A = 11.9 ± 2.0 seconds vs. RTLS-D = 36.0 ± 5.7 seconds, p < 0.001), rooms searched to find patient (RTLS-A = 1.0 ± 1.06 vs. RTLS-D = 3.8 ± 0.5, p < 0.001), and number of clicks to access patient data (RTLS-A = 1.0 ± 0.06 vs. RTLS-D = 4.1 ± 0.13, p < 0.001) were significantly reduced with RTLS-A relative to RTLS-D. There was no significant difference between RTLS-A and RTLS-D for patient identification accuracy. CONCLUSION This pilot demonstrated in simulation that an EHR equipped with real-time location services improved performance in locating patients and reduced error compared with an EHR without RTLS. Furthermore, RTLS decreased the number of mouse clicks required to access information. This study suggests EHRs equipped with real-time location services that automates patient location and other repetitive tasks may improve physician efficiency, and ultimately, patient safety.
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Affiliation(s)
- Kevin King
- Department of Emergency Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
| | - John Quarles
- Department of Computer Science, University of Texas at San Antonio, San Antonio, Texas, United States
| | - Vaishnavi Ravi
- Department of Computer Science, University of Texas at San Antonio, San Antonio, Texas, United States
| | - Tanvir Irfan Chowdhury
- Department of Computer Science, University of Texas at San Antonio, San Antonio, Texas, United States
| | - Donia Friday
- Department of Pediatrics, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, United States
| | - Craig Sisson
- Department of Emergency Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
| | - Yusheng Feng
- Department of Mechanical Engineering, University of Texas at San Antonio, San Antonio, Texas, United States
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24
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Mashoufi M, Ayatollahi H, Khorasani-Zavareh D. A Review of Data Quality Assessment in Emergency Medical Services. Open Med Inform J 2018; 12:19-32. [PMID: 29997708 PMCID: PMC5997849 DOI: 10.2174/1874431101812010019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/22/2018] [Accepted: 05/15/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Data quality is an important issue in emergency medicine. The unique characteristics of emergency care services, such as high turn-over and the speed of work may increase the possibility of making errors in the related settings. Therefore, regular data quality assessment is necessary to avoid the consequences of low quality data. This study aimed to identify the main dimensions of data quality which had been assessed, the assessment approaches, and generally, the status of data quality in the emergency medical services. METHODS The review was conducted in 2016. Related articles were identified by searching databases, including Scopus, Science Direct, PubMed and Web of Science. All of the review and research papers related to data quality assessment in the emergency care services and published between 2000 and 2015 (n=34) were included in the study. RESULTS The findings showed that the five dimensions of data quality; namely, data completeness, accuracy, consistency, accessibility, and timeliness had been investigated in the field of emergency medical services. Regarding the assessment methods, quantitative research methods were used more than the qualitative or the mixed methods. Overall, the results of these studies showed that data completeness and data accuracy requires more attention to be improved. CONCLUSION In the future studies, choosing a clear and a consistent definition of data quality is required. Moreover, the use of qualitative research methods or the mixed methods is suggested, as data users' perspectives can provide a broader picture of the reasons for poor quality data.
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Affiliation(s)
- Mehrnaz Mashoufi
- PhD Student of Health Information Management, School of Health Management and Information Sciences, Tehran Iran University of Medical Sciences, Tehran, Iran
| | - Haleh Ayatollahi
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Davoud Khorasani-Zavareh
- Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Health in Disaster and Emergency, School of HSE, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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25
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Kim TH, Hong KJ, Shin SD, Park GJ, Kim S, Hong N. Forecasting respiratory infectious outbreaks using ED-based syndromic surveillance for febrile ED visits in a Metropolitan City. Am J Emerg Med 2018; 37:183-188. [PMID: 29779674 PMCID: PMC7126969 DOI: 10.1016/j.ajem.2018.05.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/04/2018] [Accepted: 05/08/2018] [Indexed: 11/30/2022] Open
Abstract
Background Monitoring and detecting sudden outbreaks of respiratory infectious disease is important. Emergency Department (ED)-based syndromic surveillance systems have been introduced for early detection of infectious outbreaks. The aim of this study was to develop and validate a forecasting model of respiratory infectious disease outbreaks based on a nationwide ED syndromic surveillance using daily number of emergency department visits with fever. Methods We measured the number of daily ED visits with body temperature ≥ 38.0 °C and daily number of patients diagnosed as respiratory illness by the ICD-10 codes from the National Emergency Department Information System (NEDIS) database of Seoul, Korea. We developed a forecast model according to the Autoregressive Integrated Moving Average (ARIMA) method using the NEDIS data from 2013 to 2014 and validated it using the data from 2015. We defined alarming criteria for extreme numbers of ED febrile visits that exceed the forecasted number. Finally, the predictive performance of the alarm generated by the forecast model was estimated. Results From 2013 to 2015, data of 4,080,766 ED visits were collected. 303,469 (7.4%) were ED visits with fever, and 388,943 patients (9.5%) were diagnosed with respiratory infectious disease. The ARIMA (7.0.7) model was the most suitable model for predicting febrile ED visits the next day. The number of patients with respiratory infectious disease spiked concurrently with the alarms generated by the forecast model. Conclusions A forecast model using syndromic surveillance based on the number of ED visits was feasible for early detection of ED respiratory infectious disease outbreak.
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Affiliation(s)
- Tae Han Kim
- Department of Emergency Medicine, Seoul National University Boramae Medical Center, Republic of Korea
| | - Ki Jeong Hong
- Department of Emergency Medicine, Seoul National University Hospital, Republic of Korea.
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine, Republic of Korea.
| | - Gwan Jin Park
- Department of Emergency Medicine, Chungbuk National University Hospital, Republic of Korea
| | - Sungwan Kim
- Institute of Medical and Biological Engineering, Seoul National University, Republic of Korea.
| | - Nhayoung Hong
- Interdisciplinary Program for Bioengineering, Graduate School, Seoul National University, Republic of Korea
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26
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Electronic Medical Record in the ED: A Cross-Sectional Survey of Resuscitation Documentation Practices and Perceptions Among Emergency Department Clinicians. Pediatr Emerg Care 2018; 34:303-309. [PMID: 29596279 DOI: 10.1097/pec.0000000000001441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of this study were to describe current practices in nursing documentation of trauma and medical resuscitations across emergency departments (EDs) and explore physicians' and nurses' perceptions of electronic medical record (EMR) use for nursing documentation of resuscitations. METHODS An anonymous Web-based survey was developed and distributed to a convenience sample of ED physicians and nurses in the United States. RESULTS Of 438 respondents, 154 were nurses; 97.2% of respondents reported that their EDs use EMR generally. Of those, 51.2% use EMR to document resuscitations. When describing documentation processes, 19% (95% confidence interval [CI], 15%-23%) reported direct documentation on EMR, 18% (95% CI, 14%-21%) reported documenting on paper before transferring to EMR, and 22% (95% CI, 18%-26%) reported simultaneously documenting on EMR and paper. Thirty-seven percent of respondents reported that the "documentor" frequently performs other tasks during resuscitations. Few nurses (39.6%) and physicians (26.4%) perceived EMR as more efficient than paper. Nurses (66.2%) and physicians (51.8%) perceived paper as more complete than EMR. Few nurses (31.6%) and physicians (25.6%) agreed that paper would facilitate continuity of care better than EMR. No associations between nurses' perceptions of EMR, professional experience, or technology use were found. CONCLUSIONS Although EMR adoption was common among respondents, only half reported using EMR to document resuscitations. Even fewer reported documenting directly on EMR, whereas a significant proportion reported processes that may be inefficient, redundant, or prone to errors. Respondents endorsed mostly negative perceptions of EMR. Our findings suggest that there may be factors inherent to resuscitations and the existing EMR interfaces that render documenting resuscitations on EMR uniquely challenging.
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Raymond L, Paré G, Maillet É, Ortiz de Guinea A, Trudel MC, Marsan J. Improving performance in the ED through laboratory information exchange systems. Int J Emerg Med 2018. [PMID: 29532186 PMCID: PMC5847633 DOI: 10.1186/s12245-018-0179-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background The accessibility of laboratory test results is crucial to the performance of emergency departments and to the safety of patients. This study aims to develop a better understanding of which laboratory information exchange (LIE) systems emergency care physicians (ECPs) are using to consult their patients’ laboratory test results and which benefits they derive from such use. Methods A survey of 163 (36%) ECPs in Quebec was conducted in collaboration with the Quebec’s Department of Health and Social Services. Descriptive statistics, chi-square tests, cluster analyses, and ANOVAs were conducted. Results The great majority of respondents indicated that they use several LIE systems including interoperable electronic health record (iEHR) systems, laboratory results viewers (LRVs), and emergency department information systems (EDIS) to consult their patients’ laboratory results. Three distinct profiles of LIE users were observed. The extent of LIE usage was found to be primarily determined by the functional design differences between LIE systems available in the EDs. Our findings also indicate that the more widespread LIE usage, the higher the perceived benefits. More specifically, physicians who make extensive use of iEHR systems and LRVs obtain the widest range of benefits in terms of efficiency, quality, and safety of emergency care. Conclusions Extensive use of LIE systems allows ECPs to better determine and monitor the health status of their patients, verify their diagnostic assumptions, and apply evidence-based practices in laboratory medicine. But for such benefits to be possible, ECPs must be provided with LIE systems that produce accurate, up-to-date, complete, and easy-to-interpret information.
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Affiliation(s)
- Louis Raymond
- Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Guy Paré
- HEC Montréal, 3000, Cote-Sainte-Catherine Road, Montreal, Quebec, H3T 2A7, Canada.
| | | | - Ana Ortiz de Guinea
- HEC Montréal, 3000, Cote-Sainte-Catherine Road, Montreal, Quebec, H3T 2A7, Canada
| | - Marie-Claude Trudel
- HEC Montréal, 3000, Cote-Sainte-Catherine Road, Montreal, Quebec, H3T 2A7, Canada
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Salahuddin L, Ismail Z, Hashim UR, Raja Ikram RR, Ismail NH, Naim Mohayat MH. Sociotechnical factors influencing unsafe use of hospital information systems: A qualitative study in Malaysian government hospitals. Health Informatics J 2018. [PMID: 29521162 DOI: 10.1177/1460458218759698] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study is to identify factors influencing unsafe use of hospital information systems in Malaysian government hospitals. Semi-structured interviews with 31 medical doctors in three Malaysian government hospitals implementing total hospital information systems were conducted between March and May 2015. A thematic qualitative analysis was performed on the resultant data to deduce the relevant themes. A total of five themes emerged as the factors influencing unsafe use of a hospital information system: (1) knowledge, (2) system quality, (3) task stressor, (4) organization resources, and (5) teamwork. These qualitative findings highlight that factors influencing unsafe use of a hospital information system originate from multidimensional sociotechnical aspects. Unsafe use of a hospital information system could possibly lead to the incidence of errors and thus raises safety risks to the patients. Hence, multiple interventions (e.g. technology systems and teamwork) are required in shaping high-quality hospital information system use.
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Farmer BM, Hayes BD, Rao R, Farrell N, Nelson L. The Role of Clinical Pharmacists in the Emergency Department. J Med Toxicol 2018; 14:114-116. [PMID: 29075954 PMCID: PMC6013729 DOI: 10.1007/s13181-017-0634-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 10/05/2017] [Indexed: 10/18/2022] Open
Affiliation(s)
- Brenna M Farmer
- Division of Emergency Medicine, Weill Cornell Medical College of Cornell University, New York, NY, USA.
| | - Bryan D Hayes
- Department of Pharmacy, Massachusetts General Hospital and Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Rama Rao
- Division of Emergency Medicine, Weill Cornell Medical College of Cornell University, New York, NY, USA
| | | | - Lewis Nelson
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
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Perspectives and Uses of the Electronic Health Record Among US Pediatricians: A National Survey. J Ambul Care Manage 2018; 40:59-68. [PMID: 27902553 DOI: 10.1097/jac.0000000000000167] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Little is known about how existing electronic health records (EHRs) influence the practice of pediatric medicine. A total of 808 pediatricians participated in a survey about workflows using the EHR. The EHR was the most commonly used source of initial patient information. Seventy-two percent reported requiring between 2 and 10 minutes to complete an initial review of the EHR. Several moderately severe information barriers were reported regarding the display of information in the EHR. Pediatricians acquire information about new patients from EHRs more often than any other source. EHRs play a critical role in pediatric care but require improved design and efficiency.
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Redwood R, Knobloch MJ, Pellegrini DC, Ziegler MJ, Pulia M, Safdar N. Reducing unnecessary culturing: a systems approach to evaluating urine culture ordering and collection practices among nurses in two acute care settings. Antimicrob Resist Infect Control 2018; 7:4. [PMID: 29340148 PMCID: PMC5759376 DOI: 10.1186/s13756-017-0278-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 11/14/2017] [Indexed: 11/24/2022] Open
Abstract
Background Inappropriate ordering and acquisition of urine cultures leads to unnecessary treatment of asymptomatic bacteriuria (ASB). Treatment of ASB contributes to antimicrobial resistance particularly among hospital-acquired organisms. Our objective was to investigate urine culture ordering and collection practices among nurses to identify key system-level and human factor barriers and facilitators that affect optimal ordering and collection practices. Methods We conducted two focus groups, one with ED nurses and the other with ICU nurses. Questions were developed using the Systems Engineering Initiative for Patient Safety (SEIPS) framework. We used iterative categorization (directed content analysis followed by summative content analysis) to code and analyze the data both deductively (using SEIPS domains) and inductively (emerging themes). Results Factors affecting optimal urine ordering and collection included barriers at the person, process, and task levels. For ED nurses, barriers included patient factors, physician communication, reflex culture protocols, the electronic health record, urinary symptoms, and ED throughput. For ICU nurses, barriers included physician notification of urinalysis results, personal protective equipment, collection technique, patient body habitus, and Foley catheter issues. Conclusions We identified multiple potential process barriers to nurse adherence with evidence-based recommendations for ordering and collecting urine cultures in the ICU and ED. A systems approach to identifying barriers and facilitators can be useful to design interventions for improving urine ordering and collection practices.
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Affiliation(s)
- Robert Redwood
- Division of Infectious Disease, Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, 750 Highland Ave, Madison, Wisconsin 53705 USA
| | - Mary Jo Knobloch
- Division of Infectious Disease, Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, 750 Highland Ave, Madison, Wisconsin 53705 USA.,William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, Wisconsin 53705 USA
| | - Daniela C Pellegrini
- Department of Infectious Disease, University of Chicago Medical Center, 5841 S Maryland Ave, Chicago, Illinois 60637 USA
| | - Matthew J Ziegler
- Division of Infectious Disease, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, Pennsylvania 19104 USA
| | - Michael Pulia
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine and Public Health, 800 University Bay Drive, Madison, Wisconsin 53705 USA
| | - Nasia Safdar
- Division of Infectious Disease, Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, 750 Highland Ave, Madison, Wisconsin 53705 USA.,William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, Wisconsin 53705 USA
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Vandenberg AE, Vaughan CP, Stevens M, Hastings SN, Powers J, Markland A, Hwang U, Hung W, Echt KV. Improving geriatric prescribing in the ED: a qualitative study of facilitators and barriers to clinical decision support tool use. Int J Qual Health Care 2017; 29:117-123. [PMID: 27852639 DOI: 10.1093/intqhc/mzw129] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 10/12/2016] [Indexed: 11/14/2022] Open
Abstract
Quality problem or issue Clinical decision support (CDS) may improve prescribing for older adults in the Emergency Department (ED) if adopted by providers. Initial assessment Existing prescribing order entry processes were mapped at an initial Veterans Administration Medical Center site, demonstrating cognitive burden, effort and safety concerns. Choice of solution Geriatric order sets incorporating 2012 Beers guidelines and including geriatric prescribing advice and prepopulated order options were developed. Implementation Geriatric order sets were implemented at two sites as part of the multicomponent 'Enhancing Quality of Prescribing Practices for Older Veterans Discharged from the Emergency Department' quality improvement initiative. Evaluation Facilitators and barriers to order sets use at the two sites were evaluated. Phone interviews were conducted with two provider groups (n = 20), those 'EQUiPPED' with the interventions (n = 10, 5 at each site) and Comparison providers who were only exposed to order sets through a clickable option on the ED order menu within the patient's medical record (n = 10, 5 at each site). All providers were asked about order set 'use' and 'usefulness'. Users (n = 11) were asked about 'usability'. Lessons learned Order set adopters described 'usefulness' in terms of 'safety' and 'efficiency', whereas order set consultants and order set non-users described 'usefulness' in terms of 'information' or 'training'. Provider 'autonomy', 'comfort' level with existing tools, and 'learning curve' were stated as barriers to use. Conclusions Quantifying efficiency advantages and communicating safety benefit over preexisting practices and tools may improve adoption of CDS in ED and in other settings of care.
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Affiliation(s)
- Ann E Vandenberg
- Birmingham/Atlanta VA GRECC, Atlanta VA Medical Center, 1670 Clairmont Rd, Decatur, GA 30033, USA.,Birmingham/Atlanta VA GRECC, Birmingham VA Medical Center, 700 S. 19th St, Birmingham, AL 35233, USA.,Department of Medicine, Emory University, 201 Dowman Drive, Atlanta, GA 30322, USA
| | - Camille P Vaughan
- Birmingham/Atlanta VA GRECC, Atlanta VA Medical Center, 1670 Clairmont Rd, Decatur, GA 30033, USA.,Birmingham/Atlanta VA GRECC, Birmingham VA Medical Center, 700 S. 19th St, Birmingham, AL 35233, USA.,Department of Medicine, Emory University, 201 Dowman Drive, Atlanta, GA 30322, USA
| | - Melissa Stevens
- Birmingham/Atlanta VA GRECC, Atlanta VA Medical Center, 1670 Clairmont Rd, Decatur, GA 30033, USA.,Birmingham/Atlanta VA GRECC, Birmingham VA Medical Center, 700 S. 19th St, Birmingham, AL 35233, USA.,Department of Medicine, Emory University, 201 Dowman Drive, Atlanta, GA 30322, USA
| | - Susan N Hastings
- Durham VA GRECC and HSR&D Center, Durham VA Medical Centre, 508 Fulton St, Durham, NC 27705, USA.,Center for the Study of Aging and Department of Medicine, Duke University Medical Center 3710, Durham, NC 27710, USA
| | - James Powers
- Tennessee Valley VA GRECC, Tennessee Valley Healthcare System, 1310 24th Avenue S, Nashville, TN 37212-2637, USA.,Division of Geriatrics, Department of Medicine, Vanderbilt University School of Medicine, 7159 Vanderbilt Medical Center East, Nashville, TN 37232, USA
| | - Alayne Markland
- Birmingham/Atlanta VA GRECC, Atlanta VA Medical Center, 1670 Clairmont Rd, Decatur, GA 30033, USA.,Birmingham/Atlanta VA GRECC, Birmingham VA Medical Center, 700 S. 19th St, Birmingham, AL 35233, USA.,Department of Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294, USA
| | - Ula Hwang
- James J Peters VA Medical Center GRECC, 130 West Kingsbridge Road, GRECC, 4A-17, Bronx, NY 10468, USA.,Departments of Emergency Medicine and Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, 1428 Madison Avenue, New York, NY 10029, USA
| | - William Hung
- James J Peters VA Medical Center GRECC, 130 West Kingsbridge Road, GRECC, 4A-17, Bronx, NY 10468, USA.,Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, 1428 Madison Avenue, New York, NY 10029, USA
| | - Katharina V Echt
- Birmingham/Atlanta VA GRECC, Atlanta VA Medical Center, 1670 Clairmont Rd, Decatur, GA 30033, USA.,Birmingham/Atlanta VA GRECC, Birmingham VA Medical Center, 700 S. 19th St, Birmingham, AL 35233, USA.,Department of Medicine, Emory University, 201 Dowman Drive, Atlanta, GA 30322, USA
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Ahanhanzo YG, Kpozehouen A, Sopoh G, Sossa-Jérôme C, Ouedraogo L, Wilmet-Dramaix M. Management of information within emergencies departments in developing countries: analysis at the National Emergency Department in Benin. Pan Afr Med J 2016; 24:263. [PMID: 27800116 PMCID: PMC5075473 DOI: 10.11604/pamj.2016.24.263.9370] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 04/27/2016] [Indexed: 11/11/2022] Open
Abstract
Introduction The management of health information is a key pillar in both emergencies reception and handling facilities, given the strategic position and the potential of these facilities within hospitals, and in the monitoring of public health and epidemiology. With the technological revolution, computerization made the information systems evolve in emergency departments, especially in developed countries, with improved performance in terms of care quality, productivity and patient satisfaction. This study analyses the situation of Benin in this field, through the case of the Academic Clinic of Emergency Department of the National University Teaching Hospital of Cotonou, the national reference hospital. Methods The study is cross-sectional and evaluative. Collection techniques are literature review and structured interviews. The components rated are resources, indicators, data sources, data management and the use-dissemination of the information through a model adapted from Health Metrics Network framework. We used quantitative and qualitative analysis. Results The absence of a regulatory framework restricts the operation of the system in all components and accounts for the lack and inadequacy of the dedicated resources. Conclusion Dedication of more resources for this system for crucial needs such as computerization requires sensitization and greater awareness of the administrative authorities about the fact that an effective health information management system is of prime importance in this type of facility.
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Affiliation(s)
- Yolaine Glèlè Ahanhanzo
- Public Health Regional Institute, University of Abomey-Calavi, Benin; Center of research in Epidemiology, Biostatistics and Clinical Research, School of Public Health, Université Libre de Bruxelles, Bruxelles, Belgium
| | | | - Ghislain Sopoh
- Public Health Regional Institute, University of Abomey-Calavi, Benin
| | | | - Laurent Ouedraogo
- Public Health Regional Institute, University of Abomey-Calavi, Benin
| | - Michèle Wilmet-Dramaix
- Center of research in Epidemiology, Biostatistics and Clinical Research, School of Public Health, Université Libre de Bruxelles, Bruxelles, Belgium
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Palojoki S, Pajunen T, Saranto K, Lehtonen L. Electronic Health Record-Related Safety Concerns: A Cross-Sectional Survey of Electronic Health Record Users. JMIR Med Inform 2016; 4:e13. [PMID: 27154599 PMCID: PMC4890731 DOI: 10.2196/medinform.5238] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 12/21/2015] [Accepted: 01/23/2016] [Indexed: 11/25/2022] Open
Abstract
Background The rapid expansion in the use of electronic health records (EHR) has increased the number of medical errors originating in health information systems (HIS). The sociotechnical approach helps in understanding risks in the development, implementation, and use of EHR and health information technology (HIT) while accounting for complex interactions of technology within the health care system. Objective This study addresses two important questions: (1) “which of the common EHR error types are associated with perceived high- and extreme-risk severity ratings among EHR users?”, and (2) “which variables are associated with high- and extreme-risk severity ratings?” Methods This study was a quantitative, non-experimental, descriptive study of EHR users. We conducted a cross-sectional web-based questionnaire study at the largest hospital district in Finland. Statistical tests included the reliability of the summative scales tested with Cronbach’s alpha. Logistic regression served to assess the association of the independent variables to each of the eight risk factors examined. Results A total of 2864 eligible respondents provided the final data. Almost half of the respondents reported a high level of risk related to the error type “extended EHR unavailability”. The lowest overall risk level was associated with “selecting incorrectly from a list of items”. In multivariate analyses, profession and clinical unit proved to be the strongest predictors for high perceived risk. Physicians perceived risk levels to be the highest (P<.001 in six of eight error types), while emergency departments, operating rooms, and procedure units were associated with higher perceived risk levels (P<.001 in four of eight error types). Previous participation in eLearning courses on EHR-use was associated with lower risk for some of the risk factors. Conclusions Based on a large number of Finnish EHR users in hospitals, this study indicates that HIT safety hazards should be taken very seriously, particularly in operating rooms, procedure units, emergency departments, and intensive care units/critical care units. Health care organizations should use proactive and systematic assessments of EHR risks before harmful events occur. An EHR training program should be compulsory for all EHR users in order to address EHR safety concerns resulting from the failure to use HIT appropriately.
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Affiliation(s)
- Sari Palojoki
- University of Eastern Finland, Faculty of Social Sciences and Business Studies, Department of Health and Social Management, Kuopio, Finland.
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Greene J. IT in the ED. Ann Emerg Med 2015. [DOI: 10.1016/j.annemergmed.2015.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Rapid Electronic Provider Documentation Design and Implementation in an Academic Pediatric Emergency Department. Pediatr Emerg Care 2015; 31:798-804. [PMID: 26535503 DOI: 10.1097/pec.0000000000000600] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Many emergency departments are transitioning from paper charting to full electronic health records, which include both computerized provider order entry and provider documentation. Implementation of electronic provider documentation (EPD), in particular, has been challenging. Known benefits include legibility, medicolegal and compliance safeguards, and improved access to patient charts. Offsetting these benefits may be reductions in efficiency, patient throughput, and less provider-patient interaction. METHODS We used a rapid design process coupled with Lean principles, simulation, aggressive training, and continuous process improvement to design and implement a novel EPD system with real-time voice recognition dictation in the pediatric emergency department (PED). We used statistical process control methodologies to compare mean PED lengths of stay (LOSs) for admitted and discharged patients before and after EPD GoLive. RESULTS We were able to design, test, train, and implement a novel EPD to the PED within 7 months. There was special cause variation, with a 2.7% (5-minute) increase in overall LOS after EPD implementation. There was a temporary 9.3% (15-minute) increase in discharge LOS for 6 weeks after GoLive, with a subsequent return to a new baseline of 4.3% (7-minute) increase. There were no significant changes in admission LOS. There was overall consistent use of the voice recognition system several months after EPD rollout. There have been improving rates of compliance with chart completion over time, as a result of easier tracking and electronic reminders to complete. CONCLUSION Despite the inherent challenges involved in transitioning from paper charting to EPD, our study showed that an academic ED, EPD, can be rapidly designed and implemented while not significantly negatively impacting ED metrics such as LOS. We had consistent use of the voice dictation system after implementation. Time spent documenting after clinical shift was not reliably captured and is an important area of future research for successful EPD implementation.
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de Andrés-Lázaro AM, Sevilla-Sánchez D, Ortega-Romero MDM, Codina-Jané C, Calderón-Hernanz B, Sánchez-Sánchez M. Adecuación de la historia farmacoterapéutica y errores de conciliación en un servicio de urgencias. Med Clin (Barc) 2015; 145:288-93. [DOI: 10.1016/j.medcli.2015.02.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 02/06/2015] [Accepted: 02/26/2015] [Indexed: 11/30/2022]
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Benda NC, Meadors ML, Hettinger AZ, Ratwani RM. Emergency Physician Task Switching Increases With the Introduction of a Commercial Electronic Health Record. Ann Emerg Med 2015; 67:741-746. [PMID: 26391355 DOI: 10.1016/j.annemergmed.2015.07.514] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 07/15/2015] [Accepted: 07/22/2015] [Indexed: 11/18/2022]
Abstract
STUDY OBJECTIVE We evaluate how the transition from a homegrown electronic health record to a commercial one affects emergency physician work activities from initial introduction to long-term use. METHODS We completed a quasi-experimental study across 3 periods during the transition from a homegrown system to a commercially available electronic health record with computerized provider order entry. Observation periods consisted of pre-implementation, 1 month before the implementation of the commercial electronic health record; "go-live" 1 week after implementation; and post-implementation, 3 to 4 months after use began. Fourteen physicians were observed in each period (N=42) with a minute-by-minute observation template to record emergency physician time allocation across 5 task-based categories (computer, verbal communication, patient room, paper [chart/laboratory results], and other). The average number of tasks physicians engaged in per minute was also analyzed as an indicator of task switching. RESULTS From pre- to post-implementation, there were no significant differences in the amount of time spent on the various task categories. There were changes in time allocation from pre-implementation to go-live and go-live to pre-implementation, characterized by a significant increase in time spent on computer tasks during go-live relative to the other periods. Critically, the number of tasks physicians engaged in per minute increased from 1.7 during pre-implementation to 1.9 during post-implementation (difference 0.19 tasks per minute; 95% confidence interval 0.039 to 0.35). CONCLUSION The increase in the number of tasks physicians engaged in per minute post-implementation indicates that physicians switched tasks more frequently. Frequent task switching behavior raises patient safety concerns.
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Affiliation(s)
- Natalie C Benda
- National Center for Human Factors in Healthcare, MedStar Health, Washington, DC; Department of Industrial and Systems Engineering, University at Buffalo, SUNY, Buffalo, NY
| | - Margaret L Meadors
- National Center for Human Factors in Healthcare, MedStar Health, Washington, DC; Department of Applied-Experimental Psychology, Catholic University of America, Washington, DC
| | - A Zachary Hettinger
- National Center for Human Factors in Healthcare, MedStar Health, Washington, DC; Department of Emergency Medicine, Georgetown University Medical Center, Washington, DC
| | - Raj M Ratwani
- National Center for Human Factors in Healthcare, MedStar Health, Washington, DC; Department of Emergency Medicine, Georgetown University Medical Center, Washington, DC.
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Salahuddin L, Ismail Z. Classification of antecedents towards safety use of health information technology: A systematic review. Int J Med Inform 2015; 84:877-91. [PMID: 26238706 DOI: 10.1016/j.ijmedinf.2015.07.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 07/06/2015] [Accepted: 07/13/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This paper provides a systematic review of safety use of health information technology (IT). The first objective is to identify the antecedents towards safety use of health IT by conducting systematic literature review (SLR). The second objective is to classify the identified antecedents based on the work system in Systems Engineering Initiative for Patient Safety (SEIPS) model and an extension of DeLone and McLean (D&M) information system (IS) success model. METHODS A systematic literature review (SLR) was conducted from peer-reviewed scholarly publications between January 2000 and July 2014. SLR was carried out and reported based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. The related articles were identified by searching the articles published in Science Direct, Medline, EMBASE, and CINAHL databases. Data extracted from the resultant studies included are to be analysed based on the work system in Systems Engineering Initiative for Patient Safety (SEIPS) model, and also from the extended DeLone and McLean (D&M) information system (IS) success model. RESULTS 55 articles delineated to be antecedents that influenced the safety use of health IT were included for review. Antecedents were identified and then classified into five key categories. The categories are (1) person, (2) technology, (3) tasks, (4) organization, and (5) environment. Specifically, person is attributed by competence while technology is associated to system quality, information quality, and service quality. Tasks are attributed by task-related stressor. Organisation is related to training, organisation resources, and teamwork. Lastly, environment is attributed by physical layout, and noise. CONCLUSIONS This review provides evidence that the antecedents for safety use of health IT originated from both social and technical aspects. However, inappropriate health IT usage potentially increases the incidence of errors and produces new safety risks. The review cautions future implementation and adoption of health IT to carefully consider the complex interactions between social and technical elements propound in healthcare settings.
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Affiliation(s)
- Lizawati Salahuddin
- Advanced Informatics School, Universiti Teknologi Malaysia, Kuala Lumpur, Malaysia; Faculty of Information and Communication Technology, Universiti Teknikal Malaysia Melaka, Melaka, Malaysia.
| | - Zuraini Ismail
- Advanced Informatics School, Universiti Teknologi Malaysia, Kuala Lumpur, Malaysia
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Designing a Data-Driven Decision Support Tool for Nurse Scheduling in the Emergency Department: A Case Study of a Southern New Jersey Emergency Department. J Emerg Nurs 2015; 41:30-5. [DOI: 10.1016/j.jen.2014.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 07/09/2014] [Accepted: 07/19/2014] [Indexed: 11/21/2022]
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Abstract
This study evaluated the immediate effects of implementing an electronic health record (EHR) system on physician workflow in the emergency department. Two sets of observations were conducted in one emergency department. The first set of observations, the baseline period, was completed in the 22 days prior to the implementation of a new EHR. The second set of observations, the go-live period, was completed during the seven-day period immediately after the EHR go-live date. A comparison across four task-based categories revealed that during the go-live period there was a decrease in the proportion of time physicians spent in patient rooms and engaged with paper-based tasks, and an increase in the proportion of time physicians spent at computer stations and working with other people. In addition, physicians engaged in more information seeking behaviors during the go-live period than during the baseline period. The impact of these shifts in tasks and behaviors is discussed with a focus on the importance of fully understanding the EHR go-live process.
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Affiliation(s)
- Margaret Meadors
- The National Center for Human Factors in Healthcare, Washington, DC
| | - Natalie Benda
- The National Center for Human Factors in Healthcare, Washington, DC
| | - A. Zachary Hettinger
- The National Center for Human Factors in Healthcare, Washington, DC
- Department of Emergency Medicine, Georgetown University, Washington, DC
| | - Raj M. Ratwani
- The National Center for Human Factors in Healthcare, Washington, DC
- Department of Emergency Medicine, Georgetown University, Washington, DC
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Griffey RT, Jeffe DB, Bailey T. Emergency physicians' attitudes and preferences regarding computed tomography, radiation exposure, and imaging decision support. Acad Emerg Med 2014; 21:768-77. [PMID: 25125272 DOI: 10.1111/acem.12410] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 12/31/2013] [Accepted: 02/01/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Although computerized decision support for imaging is often recommended for optimizing computed tomography (CT) use, no studies have evaluated emergency physicians' (EPs') preferences regarding computerized decision support in the emergency department (ED). In this needs assessment, the authors sought to determine if EPs view overutilization as a problem, if they want decision support, and if so, the kinds of support they prefer. METHODS A 42-item, Web-based survey of EPs was developed and used to measure EPs' attitudes, preferences, and knowledge. Key contacts at local EDs sent letters describing the study to their physicians. Exploratory principal components analysis (PCA) was used to determine the underlying factor structure of multi-item scales, Cronbach's alpha was used to measure internal consistency of items on a scale, Spearman correlations were used to describe bivariate associations, and multivariable linear regression analysis was used to identify variables independently associated with physician interest in decision support. RESULTS Of 235 surveys sent, 155 (66%) EPs responded. Five factors emerged from the PCA. EPs felt that: 1) CT overutilization is a problem in the ED (α = 0.75); 2) a patient's cumulative CT study count affects decisions of whether and what type of imaging study to order only some of the time (α = 0.75); 3) knowledge that a patient has had prior CT imaging for the same indication makes EPs less likely to order a CT (α = 0.42); 4) concerns about malpractice, patient satisfaction, or insistence on CTs affect CT ordering decisions (α = 0.62); and 5) EPs want decision support before ordering CTs (α = 0.85). Performance on knowledge questions was poor, with only 18% to 39% correctly responding to each of the three multiple-choice items about effective radiation doses of chest radiograph and single-pass abdominopelvic CT, as well as estimated increased risk of cancer from a 10-mSv exposure. Although EPs wanted information on patients' cumulative exposures, they feel inadequately familiar with this information to make use of it clinically. If provided with patients' cumulative radiation exposures from CT, 87% of EPs said that they would use this information to discuss imaging options with their patients. In the multiple regression model, which included all variables associated with interest in decision support at p < 0.10 in bivariate tests, items independently associated with EPs' greater interest in all types of decision support proposed included lower total knowledge scores, greater frequency that cumulative CT study count affects EP's decision to order CTs, and greater agreement that overutilization of CT is a problem and that awareness of multiple prior CTs for a given indication affects CT ordering decisions. CONCLUSIONS Emergency physicians view overutilization of CT scans as a problem with potential for improvement in the ED and would like to have more information to discuss risks with their patients. EPs are interested in all types of imaging decision support proposed to help optimize imaging ordering in the ED and to reduce radiation to their patients. Findings reveal several opportunities that could potentially affect CT utilization.
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Affiliation(s)
- Richard T. Griffey
- The Division of Emergency Medicine; The Department of Internal Medicine; Washington University School of Medicine; St. Louis MO
- The Washington University Institute for Public Health; St. Louis MO
| | - Donna B. Jeffe
- The Division of Health Behavior Research; The Department of Internal Medicine; Washington University School of Medicine; St. Louis MO
- The Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital; St. Louis MO
| | - Thomas Bailey
- The Division of Infectious Diseases; The Department of Internal Medicine; Washington University School of Medicine; St. Louis MO
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Coffey C, Wurster LA, Groner J, Hoffman J, Hendren V, Nuss K, Haley K, Gerberick J, Malehorn B, Covert J. A comparison of paper documentation to electronic documentation for trauma resuscitations at a level I pediatric trauma center. J Emerg Nurs 2014; 41:52-6. [PMID: 24996509 DOI: 10.1016/j.jen.2014.04.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 02/24/2014] [Accepted: 04/02/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Although the electronic medical record reduces errors and improves patient safety, most emergency departments continue to use paper documentation for trauma resuscitations. The purpose of this study was to compare the completeness of paper documentation with that of electronic documentation for trauma resuscitations. METHODS The setting was a level I pediatric trauma center where 100% electronic documentation was achieved in August 2012. A random sample of trauma resuscitations documented by paper (n=200) was compared with a random sample of trauma resuscitations documented electronically (n=200) to identify the presence or absence of the documentation of 11 key data elements for each trauma resuscitation. RESULTS The electronic documentation more frequently captured 5 data elements: time of team activation (100% vs 85%, P<.00), primary assessment (94% vs 88%, P<.036), arrival time of attending physician (98% vs 93.5%, P<.026), intravenous fluid volume in the emergency department (94% vs 88%, P<.036), and disposition (100% vs 89.5%, P<.00). The paper documentation more often recorded one data element: volume of intravenous fluids administered prior to arrival (92.5% vs 100%, P<.00). No statistical difference in documentation rates was found for 5 data elements: vital signs, treatment by emergency medical personnel, arrival time in the emergency department, and level of trauma alert activation. DISCUSSION Electronic documentation produced superior records of pediatric trauma resuscitations compared with paper documentation. Because the electronic medical record improves patient safety, it should be adopted as the standard documentation method for all trauma resuscitations.
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Inokuchi R, Sato H, Nakamura K, Aoki Y, Shinohara K, Gunshin M, Matsubara T, Kitsuta Y, Yahagi N, Nakajima S. Motivations and barriers to implementing electronic health records and ED information systems in Japan. Am J Emerg Med 2014; 32:725-30. [PMID: 24792932 DOI: 10.1016/j.ajem.2014.03.035] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 03/20/2014] [Accepted: 03/20/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Although electronic health record systems (EHRs) and emergency department information systems (EDISs) enable safe, efficient, and high-quality care, these systems have not yet been studied well. Here, we assessed (1) the prevalence of EHRs and EDISs, (2) changes in efficiency in emergency medical practices after introducing EHR and EDIS, and (3) barriers to and expectations from the EHR-EDIS transition in EDs of medical facilities with EHRs in Japan. MATERIALS AND METHODS A survey regarding EHR (basic or comprehensive) and EDIS implementation was mailed to 466 hospitals. We examined the efficiency after EHR implementation and perceived barriers and expectations regarding the use of EDIS with existing EHRs. The survey was completed anonymously. RESULTS Totally, 215 hospitals completed the survey (response rate, 46.1%), of which, 76.3% had basic EHRs, 4.2% had comprehensive EHRs, and 1.9% had EDISs. After introducing EHRs and EDISs, a reduction in the time required to access previous patient information and share patient information was noted, but no change was observed in the time required to produce medical records and the overall time for each medical care. For hospitals with EHRs, the most commonly cited barriers to EDIS implementation were inadequate funding for adoption and maintenance and potential adverse effects on workflow. The most desired function in the EHR-EDIS transition was establishing appropriate clinical guidelines for residents within their system. CONCLUSION To attract EDs to EDIS from EHR, systems focusing on decreasing the time required to produce medical records and establishing appropriate clinical guidelines for residents are required.
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Affiliation(s)
- Ryota Inokuchi
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Hajime Sato
- Department of Health Policy and Technology Assessment, National Institute of Public Health 2-3-6 Minami, Wako, Saitama 351-0197, Japan.
| | - Kensuke Nakamura
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Yuta Aoki
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Kazuaki Shinohara
- Department of Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima 963-8558, Japan
| | - Masataka Gunshin
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Takehiro Matsubara
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Yoichi Kitsuta
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Naoki Yahagi
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Susumu Nakajima
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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Pines JM, Newman D, Pilgrim R, Schuur JD. Strategies For Integrating Cost-Consciousness Into Acute Care Should Focus On Rewarding High-Value Care. Health Aff (Millwood) 2013; 32:2157-65. [DOI: 10.1377/hlthaff.2013.0685] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Jesse M. Pines
- Jesse M. Pines ( ) is director of the Office for Clinical Practice Innovation, School of Medicine and Health Sciences, and a professor of emergency medicine and health policy at the George Washington University, in Washington, D.C
| | - David Newman
- David Newman is director of clinical research and an associate professor of emergency medicine at the Icahn School of Medicine at Mount Sinai, in New York City
| | - Randy Pilgrim
- Randy Pilgrim is past chair of the Emergency Department Practice Management Association (EDPMA) and chief medical officer of the Schumacher Group, in Lafayette, Louisiana
| | - Jeremiah D. Schuur
- Jeremiah D. Schuur is an attending physician; chief of the Division of Health Policy Translation; and director of quality, patient safety, and performance improvement, all in the Department of Emergency Medicine, Brigham and Women’s Hospital, in Boston, Massachusetts. He is also an assistant professor of emergency medicine at Harvard Medical School
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Computer-based reminder system effectively impacts physician documentation. Am J Emerg Med 2013; 32:104-6. [PMID: 24211280 DOI: 10.1016/j.ajem.2013.10.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 10/08/2013] [Accepted: 10/09/2013] [Indexed: 01/22/2023] Open
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