Evaluating the Impact of the Electronic Health Record on Patient Flow in a Pediatric Emergency Department
12 August 2010
accepted: 22 January 2011
16 December 2017 (online)
Background: There is little data on the effect of the EHR on emergency department (ED) efficiency. Objective: 1) to quantify the effect of the EHR on patient flow in an academic pediatric ED. 2) to analyze the effects of patient census, boarding time, staffing hours, and acuity on the mean daily ED length-of-stay (LOS) and triage-to-provider time.
Methods: ED performance was compared before and after the implementation of an EHR in May 2008. Six month intervals were used with a 5 month period of adjustment between the pre- and post-EHR intervals. 34791 patient visits met inclusion criteria. Multiple linear regression was used to evaluate the LOS and triage-to-provider time as influenced by internal and external variables affecting the ED.
Results: Daily patient census increased by 5.8% (p<0.01) without a change in rate of ED admissions. Nursing and practitioner hours increased by 19.7% and 16.1%, respectively because of the increased census and a perceived slowing associated with the EHR. Following the implementation, LOS remained unchanged while triage-to-provider time increased by 5 minutes per patient (p<0.05). Factors that independently affected both LOS and triage-to-provider time included census, acuity, and practitioner hours (p<0.05). When controlling for these independent variables, the use of an EHR did not affect either outcome variable (p=0.251, 0.074 respectively). However, patient flow was worsened with the EHR during days of extremely high patient census.
Conclusion: An ED-EHR was associated with a modest increase in time to see a medical provider but was not associated with a change in overall LOS. When controlling for factors including patient volume, acuity, and staffing, the EHR did not independently affect ED patient flow. The EHR may have a more profound impact on ED performance during periods of extremely high census.
- 1 Jamal A, McKenzie K, Clark M. The impact of health information technology on the quality of medical and health care: a systematic review. HIM J 2009; 38 (03) 26-37. PMid:19875852.
- 2 Adams WG, Mann AM, Bauchner H. Use of an electronic medical record improves the quality of urban pediatric perimary care. Pediatrics 2003; 111 (03) 626-632. doi:10.1542/peds.111.3.626 PMid:12612247.
- 3 Shekelle PG, Morton SC, Keeler EB. Costs and benefits of health information technology. Evid Rep Technol Assess 2006; 132: 1-71.
- 4 Chaudhry B, Wang J, Wu S, Maglione M, Mojica W, Roth E. et al. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Ann Intern Med 2006; 144 (10) 742-752. PMid:16702590.
- 5 Zaroukian MH, Sierra A. Benefiting from ambulatory EHR implementation: solidarity, six sigma, and willingness to strive. J Healthc Inf Manag 2006; 1: 53-60.
- 6 Samaan ZM, Klein MD, Mansour ME, DeWitt TG. The impact of the electronic health record on an academic pediatric primary care center. J Ambul Care Manage 2009; 32 (03) 180-187. PMid:19542807.
- 7 Spalding SC, Mayer PH, Ginde AA, Lowenstein SR, Yaron M. Impact of computerized physician order entry on ED patient length of stay. Am J Emerg Med. 2010
- 8 Poissant L, Pereira J, Tamblyn R, Kawasumi Y. The impact of electronic health records on time efficiency of physicians and nurses: a systematic review. J Am Med Inform Assoc 2005; 12 (05) 505-516. doi:10.1197/jamia. M1700 PMid:15905487 PMCid:1205599.
- 9 111th U. S. Congress.. American Recovery and Reinvestment Act of 2009. Title XXX –Health Information Technology and Quality. In: http://frwebgate.access.gpo.gov/cgibin/getdoc.cgi?dbname=111_cong_bills&docid=f:h1enr.pdf.
- 10 Irani JS, Middleton JL, Marfatia R, Omana ET, D‘Amico F. The use of electronic health records in the exam room and patient satisfaction: a systematic review. J Am Board Fam Med 2009; 22 (05) 553-562. doi:10.3122/jabfm.2009.05.080259 PMid:19734402.
- 11 Derlet RW, Richards JR. Overcrowding in the nation’s emergency departments: complex causes and disturbing effects. Ann Emerg Med 2000; 35 (01) 63-68. doi:10.1016/S0196-0644(00)70105-3.
- 12 Hostetler MA, Mace S, Brown K, Finkler J, Hernandez D, Krug SE. et al. Emergency department overcrowding and children. Pediatr Emerg Care 2007; 23 (07) 507-515. doi:10.1097/01.pec.0000280518.36408.74 PMid:17666940.
- 13 Trzeciak S, Rivers EP. Emergency department overcrowding in the United States: an emerging threat to patient safety and public health. Emerg Med J 2003; 20 (05) 402-405. doi:10.1136/emj.20.5.402 PMid:12954674 PMCid:1726173.
- 14 Vartak S, Crandall DK, Brokel JM, Wakefield DS, Ward MM. Transformation of emergency department processes of care with EHR, CPOE, and ER event tracking systems. HIM J 2009; 38 (02) 27-32. PMid:19546485.
- 15 Timm NL, Ho ML, Luria JW. Pediatric emergency department overcrowding and impact on patient flow outcomes. Acad Emerg Med 2008; 15: 832-837. doi:10.1111/j.1553-2712.2008.00224.x PMid:18821860.