Control, Alt, Delete: Retooling Processes for Successful EDIS Delivery

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Control, Alt, DeleteRetooling Processes for
Successful EDIS Delivery

• Todd Rothenhaus, MD FACEP

Chief Medical Information Officer Caritas Christi
Health Care System Attending Emergency
Physician St. Elizabeths Medical Center Boston,
MA Co-chair, Emergency Care Special Interest
Group Health Level 7 Immediate Past
Chair Section of Emergency Medical
Informatics American College of Emergency
Medicine
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A Boston Medical Center

• Level 1 Trauma Center
• 127,000 annual visits
• 38 full time attendings and NPs
• gt200 rotating house staff per year
• gt150 full time RN staff
• 5 geographically separate locations

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The Emergency Department

• People
• Architecture
• Communication

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Health Care Deliverables

• Medications
• Procedures
• Education

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ED IT Adopters

• Well Tuned Emergency Department
• Disaster Area
• Begging HIS to computerize
• CPOE Victim
• Reluctant Adopter
• Homegrown Developer

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Basic ED workflow
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Basic ED workflows

• Most variable workflows
• Triage
• Discharge
• Patient Entry
• 1 versus 2 step triage
• Meet/greet
• Full versus variable/minimal triage
• 5 level triage (CDS)
• Triage directly to a room
• Bedside registration
• Radiology and labs prior to evaluation

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Triage Workflow

• Patients brought directly to the treatment area
  should get a different kind of triage than
  patients who wait
• Meet or greet
• Regular triage
• Bedside triage
• Uncouple triage and RN care

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ED Communication Workflow

• Roll out EDIS to supporting departments
• Registration
• Admitting
• Housekeeping
• Radiology
• Pharmacy

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EDIS Data and Reports

• Legacy data
• System generated reports
• Data mining the back end

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Welch S, Augustine J, Camargo CA Jr, Reese C.
Emergency department performance measures and
benchmarking summit. Acad Emerg Med. 2006
Oct13(10)1074-80.
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How EDIS data is captured

• Active tracking vs. passive tracking
• What events are being associated with each
  timestamp
• Consider users ability to game the system

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How (not) to Lie with EDIS Statistics

• The best
• Overall LOS
• Time to Room
• Time to Registration
• The worst
• Time to be seen by MD
• Disposition to departure

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Profiling and benchmarking

• Physician statistics
• Patients per hour
• RN statistics
• Patient-hours

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Summary

• Small changes in workflow can substantially
  perturb ED operations
• Implementations take much longer to recover from
  than you think
• Consider triage and disposition workflows
  carefully do not overload triage
• Roll out EDIS to supporting departments
• EDIS data has substantial limitations