A Custom-Developed Emergency Department Provider Electronic Documentation System Reduces Operational Efficiency
| Autor: | Adam B. Landman, Sukhjit S. Takhar, Ryan Ribeira, Joshua Feblowitz, Michael J. Ward |
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| Rok vydání: | 2017 |
| Předmět: |
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Documentation system Documentation Efficiency Organizational Article 03 medical and health sciences 0302 clinical medicine Outcome Assessment Health Care Health care Electronic Health Records Humans Operational efficiency Medicine 030212 general & internal medicine Retrospective Studies business.industry 030208 emergency & critical care medicine Retrospective cohort study Regression analysis Emergency department Length of Stay Middle Aged medicine.disease Patient Discharge Confidence interval Massachusetts Emergency Medicine Female Medical emergency Emergency Service Hospital business |
| Zdroj: | Annals of Emergency Medicine. 70:674-682.e1 |
| ISSN: | 0196-0644 |
| DOI: | 10.1016/j.annemergmed.2017.05.032 |
| Popis: | Study objective Electronic health record implementation can improve care, but may also adversely affect emergency department (ED) efficiency. We examine how a custom, ED provider, electronic documentation system (eDoc), which replaced paper documentation, affects operational performance. Methods We analyzed retrospective operational data for 1-year periods before and after eDoc implementation in a single ED. We computed daily operational statistics, reflecting 60,870 pre- and 59,337 postimplementation patient encounters. The prespecified primary outcome was daily mean length of stay; secondary outcomes were daily mean length of stay for admitted and discharged patients and daily mean arrival time to disposition for admitted patients. We used a prespecified multiple regression model to identify differences in outcomes while controlling for prespecified confounding variables. Results The unadjusted change in length of stay was 8.4 minutes; unadjusted changes in secondary outcomes were length of stay for admitted patients 11.4 minutes, length of stay for discharged patients 1.8 minutes, and time to disposition 1.8 minutes. With a prespecified regression analysis to control for variations in operational characteristics, there were significant increases in length of stay (6.3 minutes [95% confidence interval 3.5 to 9.1 minutes]) and length of stay for discharged patients (5.1 minutes [95% confidence interval 1.9 to 8.3 minutes]). There was no statistically significant change in length of stay for admitted patients or time to disposition. Conclusion In our single-center study, the isolated implementation of eDoc was associated with increases in overall and discharge length of stay. Our findings suggest that a custom-designed electronic provider documentation may negatively affect ED throughput. Strategies to mitigate these effects, such as reducing documentation requirements or adding clinical staff, scribes, or voice recognition, would be a valuable area of future research. |
| Databáze: | OpenAIRE |
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