Clinical information system and process redesign improves emergency department efficiency.
BACKGROUND
Fueled by a decade-long increase in emergency department (ED) visits with a concomitant decrease in hospital bed capacity and the number of hospital EDs, ED crowding has reached crisis proportions. Robust information systems and process redesign are two strategies to improve the safety and quality of emergency care. At the ED at the Mount Sinai Medical Center, an urban, tertiary care academic medical center in New York City, elements of departmental work flow were redesigned to streamline patient throughput before implementation of a fully integrated emergency department information system (EDIS) with patient tracking, computerized charting and order entry, and direct access to patient historical data from the hospital data repository. Pre- and postintervention data were analyzed to examine the impact on (ED) efficiency.


RESULTS
The length of stay for all patients (arrival to time patient left ED) decreased by 1.94 hours, from 6.69 (n = 508) pre-intervention to 4.75 (n = 691) postintervention (p < .001); doctor-to-disposition time (first doctor-patient contact to disposition decision) decreased by 1.90 hours, from 3.64 (n = 508) to 1.74 (n = 691; p < .001); door-to-doctor time (triage to first doctor-patient contact) decreased by 0.54 hours, from 1.22 (n = 508) to 0.68 (n = 691; p < .001). X-ray turnaround time (TAT) decreased by 0.18 hours from 0.92 (n = 60) to 0.74 (n = 108; p = .179); computerized tomography (CT) scan TAT decreased by 1.56 hours, from 3.89 (n = 40) to 2.33 (n = 29; p < .001), lab TAT decreased by 0.59 hours, from 2.03 (n = 121) to 1.44 (n = 271; p = .006).


CONCLUSIONS
Increasing the clinical information available at the bedside and improving departmental work flow through EDIS implementation and process redesign led to decreased patient throughput times and improved ED efficiency.
Baumlin
Kevin M
KM
Department of Emergency Medicine, Mount Sinai School of Medicine, New York City, USA. kevin.baumlin@mssm.edu
Shapiro
Jason S
JS
Weiner
Corey
C
Gottlieb
Brett
B
Chawla
Neal
N
Richardson
Lynne D
LD
D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006801:Humans; D007256:Information Systems; D007902:Length of Stay; D009519:New York City; D010043:Outcome and Process Assessment, Health Care; D057188:Workflow