Characterizing workflow for pediatric asthma patients in emergency departments using electronic health records.
OBJECTIVE
The purpose of this study was to describe a workflow analysis approach and apply it in emergency departments (EDs) using data extracted from the electronic health record (EHR) system.


METHODS
We used data that were obtained during 2013 from the ED of a children's hospital and its four satellite EDs. Workflow-related data were extracted for all patient visits with either a primary or secondary diagnosis on discharge of asthma (ICD-9 code=493). For each patient visit, eight different a priori time-stamped events were identified. Data were also collected on mode of arrival, patient demographics, triage score (i.e. acuity level), and primary/secondary diagnosis. Comparison groups were by acuity levels 2 and 3 with 2 being more acute than 3, arrival mode (ambulance versus walk-in), and site. Data were analyzed using a visualization method and Markov Chains.


RESULTS
To demonstrate the viability and benefit of the approach, patient care workflows were visually and quantitatively compared. The analysis of the EHR data allowed for exploration of workflow patterns and variation across groups. Results suggest that workflow was different for different arrival modes, settings and acuity levels.


CONCLUSIONS
EHRs can be used to explore workflow with statistical and visual analytics techniques novel to the health care setting. The results generated by the proposed approach could be utilized to help institutions identify workflow issues, plan for varied workflows and ultimately improve efficiency in caring for diverse patient groups.


CONCLUSIONS
EHR data and novel analytic techniques in health care can expand our understanding of workflow in both large and small ED units.
College of Nursing, University of Colorado-Denver | Anschutz Medical Campus, Aurora, CO, USA. Electronic address: Mustafa.ozkaynak@ucdenver.edu.
Mustafa
M
Ozkaynak
College of Nursing, University of Colorado-Denver | Anschutz Medical Campus, Aurora, CO, USA.
Oliwier
O
Dziadkowiec
Section of Emergency Medicine, Children's Hospital Colorado, Aurora, CO, USA.
Rakesh
R
Mistry
College of Nursing, University of Colorado-Denver | Anschutz Medical Campus, Aurora, CO, USA.
Tiffany
T
Callahan
College of Engineering, University of Massachusetts, Amherst, MA, USA.
Ze
Z
He
Children's Hospital Colorado, Aurora, CO, USA.
Sara
S
Deakyne
Seattle Children's Research Institute, Seattle, WA, USA.
Eric
E
Tham
D001249:Asthma / Q000175:diagnosis / Q000628:therapy; D002648:Child; D057286:Electronic Health Records; D004636:Emergency Service, Hospital; D006801:Humans; D038801:International Classification of Diseases; D013223:Statistics as Topic; D057188:Workflow
Asthma; Emergency departments; Markov Chains; Visualization; Workflow