Hospital-Based Emergency Care At the Breaking Point (2007) / Chapter Skim
Currently Skimming:
5 Technology and Communications
5 Technology and Communications
Pages 165-208
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 165... ...
Thompson, who tells him to call an ambulance to bring him to the Eastern Hospital emergency department (ED)
|
From page 166... ...
Luckily, the pain is being caused by a kidney stone instead of something more serious. With a single click the emergency physician is able to iew the digital images and confirm the findings.
|
From page 167... ...
This chapter describes the current state of the art in health care IT and highlights several specific IT tools that have proven ability to improve emergency care in six key areas: management and coordination of patient flow and hospital patient care, linkage of the ED to the wider health care community, clinical decision support, clinical documentation, training and knowledge enhancement, and population health monitoring. The chapter also considers some of the new clinical technologies that are expected to impact emergency care within the coming decade.
|
From page 168... ...
cited "reducing medical errors and improving patient safety" as their top IT priority. Of these respondents, nearly two-thirds indicated their next IT
|
From page 169... ...
Progress toward a highly integrated and coordinated emergency care system has been slow even though the value of such integration and coordination has long been recognized (NHTSA, 1996)
|
From page 170... ...
. This initiative can lead to significant improvements in emergency care, as well as in other areas.
|
From page 171... ...
Among other factors, this urgency stems from the life-anddeath nature of emergency care, the myriad threats to such care posed by ED crowding, and the increasingly common role of the ED as the public's portal of choice for medical services. Six key areas of emergency care could immediately benefit from an infusion of IT: • Management and coordination of patient flow and hospital patient care -- Technologies such as electronic dashboards, radio frequency tracking, and wireless communications systems can help ED staff manage patients and maintain control over department workflow.
|
From page 172... ...
• Population health monitoring -- Emerging IT applications can provide real-time population health monitoring, including syndromic surveillance and outbreak detection, necessary for many public health and homeland security priorities. In each of these areas, IT has the potential to significantly enhance the timeliness, safety, and quality of emergency care, improving patient flow and reducing health costs in the process.
|
From page 173... ...
TECHNOLOGY AND COMMUNICATIONS Electronic Dashboards The pre-IT solution for managing ED flow was for staff to track patients on a centrally visible whiteboard. Commonly arranged in the form of a grid, this whiteboard contained a list of patients and their locations, current providers, the status of the visit, and orders to be completed.
|
From page 174... ...
. And the ability to better communicate estimated wait times to patients using dashboard technology has been found to improve patient satisfaction with emergency care (Thompson et al., 1996)
|
From page 175... ...
Of note, users of such technology must remain cognizant of their surroundings to ensure that patient confidentiality is protected and that ambient noise does not degrade voice recognition. Wireless Registration In a typical ED, several components of emergency care occur simultaneously.
|
From page 176... ...
. With respect to emergency care in particular, a number of benefits are associated with these technologies, such as reduction of the time required to capture images (Redfern et al., 2002)
|
From page 177... ...
The potential of EHRs to improve patient care in all health care settings has been well recognized for more than a decade, with the Institute of Medicine (IOM) having called for the complete elimination of paper-based medical records as early as 1991 (IOM, 1991)
|
From page 178... ...
In addition, the real-time capture and transmission of EMS dispatch data can improve the coordination of prehospital and emergency care for critically ill patients (Teich et al., 2002)
|
From page 179... ...
has provided seed money through grants to a number of RHIO startups. Telemedicine Telemedicine has a number of important applications for improving the delivery of emergency and trauma services in remote locations, including emergency patient care, education, research, and patient follow-up.
|
From page 180... ...
In an effort to streamline care, referring physicians often wish to share insights and suggestions about the patient they are referring. In large EDs, however, it is often impractical and interruptive to have a busy ED physician stop patient care to take a call from a referring physician.
|
From page 181... ...
TECHNOLOGY AND COMMUNICATIONS Once the information has been submitted, the system prints out a summary report and attaches an electronic copy of the report to the patient's EHR. Thus even if the triage staff is unable to match the paper referral to the appropriate patient chart, clinical staff can still see and act on the information via the dashboard display.
|
From page 182... ...
Automated Triage Systems Automated triage systems are commonly used to refer patients to the appropriate levels of medical care. For example, nurse call centers routinely use protocols and guidelines to triage patients to self-care, primary care, or emergency care.
|
From page 183... ...
. It has excellent interrater reliability and a high correlation with the need for intensive care unit (ICU)
|
From page 184... ...
. They also have been found to enhance patient safety by providing extra safeguards for high-risk situations (Kuperman et al., 2001)
|
From page 185... ...
As a result, it is especially important that CPOE systems for the ED be specifically designed for use in that setting and that their impacts on the quality, timeliness, and safety of emergency care be carefully monitored (Handler et al., 2004)
|
From page 186... ...
. If the time needed to consult a CDSS inadvertently slowed the delivery of emergency care, for example, the system's implementation would result in far more negative consequences than the benefits its use could offer.
|
From page 187... ...
Given the rapidly expanding volume of medical information and the wide variety of conditions that present to an ED, easy access to electronic references is key to improving patient safety (Bates et al., 1999)
|
From page 188... ...
. The potential of IT-based training and simulation recently led the Society of Academic Emergency Medicine to issue the following recommendation: EM residency programs should consider the use of high-fidelity patient simu lators to enhance the teaching and evaluation of core competencies among trainees.
|
From page 189... ...
This can be true whether the condition involves an infectious disease such as tuberculosis or a high-impact injury, such as a gunshot wound (Kellermann et al., 2001)
|
From page 190... ...
Such technologies can be expected to diffuse gradually from the hospital to the prehospital environment. For example, strategically locating advanced imaging equipment in the ED would shorten patient wait times and improve throughput by accelerating diagnosis.
|
From page 191... ...
These ultrasound systems will become a mainstay in the ED as they allow the emergency physician to perform focused echocardiography and vascular studies, resulting in earlier diagnosis and treatment. Several manufacturers offer portable systems that can be used at the bedside.
|
From page 192... ...
This translates into samples that can be extracted, amplified, and detected in less than 25 minutes, significantly reducing patient wait times and expediting diagnosis. An added benefit is that rapid diagnostics can be used to determine whether a patient is a carrier of a disease that could potentially harm other patients and health care workers.
|
From page 193... ...
A number of hospital IT tools have been demonstrated to be effective in improving patient flow and efficiency, and to have a direct and substantial impact on ED crowding and the quality of emergency care. Given the sporadic adoption of these IT tools to date, the committee believes hospitals should increase their efforts to enhance their IT capabilities that impact emergency and trauma care.
|
From page 194... ...
Adding to these challenges is the fact that access to capital may be particularly limited for certain types of health care organizations, including the nonprofit hospitals that provide much of the nation's safety net emergency care. Further, while large for-profit hospitals and health plans may have ready capital to invest, they may lack the leverage and incentives needed to implement various IT tools (IOM, 2001)
|
From page 195... ...
. Similarly, with IT-related improvements in quality and efficiency and reductions in medical errors, it is estimated that Medicare could save up to 30 percent of its annual spending (The Lewin Group, 2005)
|
From page 196... ...
Providers participating in the Massachusetts Healthcare Data Consortium, for example, have access to pharmacy prescription databases for treatment purposes. Such information is critical in emergency care as many patients arriving in the ED are unable to tell staff exactly which medicines they take, whether because of alterations to their mental status, forgetfulness, or the sheer number of different pills involved.
|
From page 197... ...
and Patrick J Kennedy (D-Rhode Island)
|
From page 198... ...
Currently there are more than 780,000 physicians and 2.2 million nurses, as well as many other health care providers, involved in the delivery of patient care in the United States (HRSA, 2003)
|
From page 199... ...
. An essential step in realizing the potential of health care IT to improve patient flow and enhance the quality, safety, and timeliness of patient care is the creation of a national health information infrastructure, discussed earlier.
|
From page 200... ...
While technical solutions exist, there must also be trade-offs between the capabilities of systems and the requirements for confidentiality. PRIORITIZING INVESTMENTS IN EMERGENCY CARE INFORMATION TECHNOLOGY The specific costs and benefits of many of the technologies described above to individual hospitals are largely unknown, and can be expected to vary according to the individual circumstances and the technology infra BOX 5-3 Roadmap for the Implementation of Health Information Technologies In an ideal world, where all hospitals and health care systems were equally flush with capital and similarly motivated to invest in new health care information technologies, the IT tools known to improve the quality, safety, and timeliness of emergency care would be immediately adopted and embraced by staff and patients alike.
|
From page 201... ...
Given these inherent variations, it would be difficult to prioritize the many technologies in a way that could be generalized to all hospitals. However, the committee identified categories of technologies that would have a substantial impact on emergency care and that could feasibly be adopted by many institutions within 3–5 years: • Technologies that facilitate patient flow management, such as electronic dashboards and tracking systems • Technologies that improve the continuity of care across the continuum of care, particularly EMS–hospital system linkages and RHIOs that enhance the information available to clinicians across settings Clinical documentation programs are the next logical choice for many hospitals and health care systems seeking to improve patient flow and enhance quality and safety.
|
From page 202... ...
. SUMMARY OF RECOMMENDATIONS 5.1: Hospitals should adopt robust information and communica tions systems to improve the safety and quality of emergency care and enhance hospital efficiency.
|
From page 203... ...
2003. Heterogeneous effect of an emergency department expert charting system.
|
From page 204... ...
2004. The validity of chief complaint and discharge diagnosis in emergency department-based syndromic surveillance.
|
From page 205... ...
2002. Emergency department triage of patients infected with HIV.
|
From page 206... ...
2003. An inexpensive modification of the laboratory computer display changes emergency physicians' work habits and perceptions.
|
From page 207... ...
2003. Information technology in emergency medicine residency-affiliated emergency departments.
|
From page 208... ...
2004. Information management in the emergency department.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.