title: The Boston Marathon Bombings Mass Casualty Incident: One Emergency Department's Information Systems Challenges and Opportunities.
abstract: Emergency department (ED) information systems are designed to support efficient and safe emergency care. These same systems often play a critical role in disasters to facilitate real-time situation awareness, information management, and communication. In this article, we describe one ED's experiences with ED information systems during the April 2013 Boston Marathon bombings. During postevent debriefings, staff shared that our ED information systems and workflow did not optimally support this incident; we found challenges with our unidentified patient naming convention, real-time situational awareness of patient location, and documentation of assessments, orders, and procedures. As a result, before our next mass gathering event, we changed our unidentified patient naming convention to more clearly distinguish multiple, simultaneous, unidentified patients. We also made changes to the disaster registration workflow and enhanced roles and responsibilities for updating electronic systems. Health systems should conduct disaster drills using their ED information systems to identify inefficiencies before an actual incident. ED information systems may require enhancements to better support disasters. Newer technologies, such as radiofrequency identification, could further improve disaster information management and communication but require careful evaluation and implementation into daily ED workflow.
authors.affiliation: Brigham and Women's Hospital, Department of Emergency Medicine, Boston, MA; Harvard Medical School, Boston, MA; Information Systems, Partners Healthcare, Wellesley, MA. Electronic address: alandman@partners.org.
authors.forename: Adam
authors.initials: A
authors.lastname: Landman
authors.affiliation: Brigham and Women's Hospital, Department of Emergency Medicine, Boston, MA; Harvard Medical School, Boston, MA.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Teich
authors.affiliation: Brigham and Women's Hospital, Department of Emergency Medicine, Boston, MA; Harvard Medical School, Boston, MA.
authors.forename: Peter
authors.initials: P
authors.lastname: Pruitt
authors.affiliation: Information Systems, Partners Healthcare, Wellesley, MA.
authors.forename: Samantha E
authors.initials: SE
authors.lastname: Moore
authors.affiliation: Information Systems, Partners Healthcare, Wellesley, MA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Theriault
authors.affiliation: Brigham and Women's Hospital, Department of Emergency Medicine, Boston, MA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Dorisca
authors.affiliation: Brigham and Women's Hospital, Department of Emergency Medicine, Boston, MA.
authors.forename: Sheila
authors.initials: S
authors.lastname: Harris
authors.affiliation: Brigham and Women's Hospital, Department of Emergency Medicine, Boston, MA.
authors.forename: Heidi
authors.initials: H
authors.lastname: Crim
authors.affiliation: Department of Health and Human Services, Washington, DC.
authors.forename: Nicole
authors.initials: N
authors.lastname: Lurie
authors.affiliation: Brigham and Women's Hospital, Department of Emergency Medicine, Boston, MA; Harvard Medical School, Boston, MA; National Preparedness Leadership Initiative, Cambridge, MA; Partners Healthcare Emergency Preparedness, Boston, MA.
authors.forename: Eric
authors.initials: E
authors.lastname: Goralnick
mesh_terms: D054042:Bombs; D001900:Boston; D057286:Electronic Health Records; D004636:Emergency Service, Hospital / Q000458:organization & administration; D006751:Hospital Information Systems / Q000458:organization & administration; D006801:Humans; D054527:Mass Casualty Incidents; D010355:Patient Identification Systems; D023481:Terrorism