title: Evaluating the impact of the electronic health record on patient flow in a pediatric emergency department.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Children's National Medical Center - Division of Emergency Medicine , Washington, District of Columbia, United States.
authors.forename: Dj
authors.initials: Dj
authors.lastname: Mathison
authors.forename: Jm
authors.initials: J
authors.lastname: Chamberlain
keywords: Emergency medical services; electronic health records; hospital information systems; organizational efficiency; workflow