It’s not often that an emergency department (ED) sets the implementation pace of information technology for the rest of the hospital. But that’s just what happened more than a decade ago at St. Elizabeth Hospital – part of the Franciscan Missionaries of our Lady Health System – in Gonzales, La., when its ED deployed an information system well before the hospital itself began its quest for an electronic medical record (EMR) solution.
Physicians and nurses in the 17-bed ED that serves more than 30,000 patients annually quickly latched onto the technology, tracking patient data, sending orders and measuring key statistics. However, as government regulations and quality measure reporting became more rigorous, leaders at St. Elizabeth noticed that its original ED information system (EDIS) choice wasn’t up to the challenge, preventing clinicians from thoroughly and accurately documenting data necessary to comply with Joint Commission and other reporting measures. After just two years, the organization began searching for a more robust and user-friendly EDIS solution.
St. Elizabeth ED staff desired an information system that would provide as little disruption as possible to nurse and physician workflow. It also wanted a solution that would facilitate efficient, quality care yet not come between patients and clinicians. Finally, the hospital required an EDIS that enabled clinicians to accurately and thoroughly collect all data required for not only government reporting, but also for the ED’s own internal performance measures. After evaluating various EDIS solutions, St. Elizabeth selected a best-of-breed technology called CMR.
ED staff got their wish with a solution that integrated seamlessly with their traditional workflows, mimicking the documentation activities commonly associated with paper-based medical records.
Patient-centered care
St. Elizabeth’s ED puts a premium on delivering quality patient-centered care. In order to meet that standard, staff needs to have patient information at their fingertips as well as the ability to track throughput. The EDIS affords staff with department-specific tools that consolidate patient data on a central, automated platform, which means they don’t have to dig through paper charts for the right information. St. Elizabeth now tracks all patient encounters, documenting activities each step of the way – from arrival to medical screening to discharge.
Recognizing that patients often feel rushed by busy physicians and interrupted by technology tools, St. Elizabeth ED staff chose an EDIS that would allow caregivers to focus exclusively on patients without the aid of clipboards, notepads, computers or other devices. All information from the patient encounter is recorded on computers located in the nurse’s station, freeing clinicians from any documentation – electronic or otherwise – at the bedside. Since implementing the new system and changes to the workflow, St. Elizabeth has achieved increased patient satisfaction.
St. Elizabeth staff is also able to better manage patient experience by utilizing the whiteboard features of the EDIS. Unlike other hospitals and EDs that allow EMRs to be completed at a later time, a patient remains on the whiteboard until the clinical disposition has been completed and the patient discharged. The whiteboard is crucial to maintaining efficient throughput and expediting work-related activities.
St. Elizabeth physicians are creating significant care-giving efficiencies through their ability to place lab, radiology and pharmacy orders and receive alerts when results are delivered. The EDIS solution also notes the time the visit concluded with either an admission into the hospital or a discharge. Individuals are also assured that the technology helps create a safer environment. The EDIS guides clinicians through required documentation based on their risk level with built-in logic and alerts caregivers to potential adverse drug-to-drug and drug-to-allergy interactions. The result is a more efficient staff and improved clinical outcomes for the patient.
Moreover, St. Elizabeth is improving patient care and safety by integrating risk mitigation and clinician-defined clinical rules content that help ED physicians proactively identify high-risk patients. Using the EDIS software, physicians review documentation that indicates a high risk, such as chest pain, and match it against the patient’s history, physical exam, notes and diagnosis. The patient encounter is complete only after the physician reconciles the diagnosis and the identified risk.
Better clinical outcomes
In an emergency medicine setting, maintaining the proper procedures can be difficult, if not impossible, when traumas, illnesses and other medical emergencies fill the department beyond capacity. The ability to implement patient flow processes improves the safety of patients in the ED by reducing the time patients wait to be seen and by expediting admission to the most appropriate hospital unit. It also significantly reduces the number of patients who leave without being seen.
Since implementing its new EDIS system, St. Elizabeth’s ED has realized significant operational and clinical benefits, including a decrease in patient turnaround time, length of stay and number of patients who leave without being seen.
St. Elizabeth’s ED is meeting meaningful-use standards by automating and printing discharge instruction forms with the EDIS system. The solution also allows EDs to make discharge instructions available via email to the patient. Similarly, hospital transfer information can be part of the patient’s electronic record that follows them from the ED to the hospital or primary care setting. Moreover, the EDIS is current and up to date with all regulatory requirements, and documentation of HEDIS core measures and Joint Commission-required standards and CMS directives.
In a busy ED environment where time is a commodity, St. Elizabeth’s staff has come to depend upon the new EDIS system as a means to improve the quality and delivery of healthcare, as well as patient outcomes.
About the author
Chris Trevino is the medical director of emergency medicine for St. Elizabeth Hospital. For more information on St. Elizabeth’s, click here.
