Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Oct 7;6(4):611-8.
doi: 10.4338/ACI-2015-04-RA-0044. eCollection 2015.

Quality Outcomes in the Surgical Intensive Care Unit after Electronic Health Record Implementation

V H Flatow  1 , N Ibragimova  1 , C M Divino  1 , D S A Eshak  1 , B C Twohig  1 , A M Bassily-Marcus  1 , R Kohli-Seth  1
Affiliations

Quality Outcomes in the Surgical Intensive Care Unit after Electronic Health Record Implementation

V H Flatow et al. Appl Clin Inform. .

Abstract

Background: The electronic health record (EHR) is increasingly viewed as a means to provide more coordinated, patient-centered care. Few studies consider the impact of EHRs on quality of care in the intensive care unit (ICU) setting.

Objectives: To evaluate key quality measures of a surgical intensive care unit (SICU) following implementation of the Epic EHR system in a tertiary hospital.

Methods: A retrospective chart review was undertaken to record quality indicators for all patients admitted to the SICU two years before and two years after EHR implementation. Data from the twelve-month period of transition to EHR was excluded. We collected length of stay, mortality, central line associated blood stream infection (CLABSI) rates, Clostridium difficile (C. diff.) colitis rates, readmission rates, and number of coded diagnoses. To control for variation in the patient population over time, the case mix indexes (CMIs) and APACHE II scores were also analyzed.

Results: There was no significant difference in length of stay, C. diff. colitis, readmission rates, or case mix index before and after EHR. After EHR implementation, the rate of central line blood stream infection (CLABSI) per 1 000 catheter days was 85% lower (2.16 vs 0.39; RR, 0.18; 95% CI, 0.05 to 0.61, p < .005), and SICU mortality was 28% lower (12.2 vs 8.8; RR, 1.35; 95% CI, 1.06 to 1.71, p < .01). Moreover, after EHR there was a significant increase in the average number of coded diagnoses from 17.8 to 20.8 (p < .000).

Conclusions: EHR implementation was statistically associated with reductions in CLABSI rates and SICU mortality. The EHR had an integral role in ongoing quality improvement endeavors which may explain the changes in CLABSI and mortality, and this invites further study of the impact of EHRs on quality of care in the ICU.

Keywords: Electronic health records; critical care; quality improvement; surgical intensive care.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest

The authors of this study report no conflicts of interest.

References

    1. Health expenditure, total (% of GDP) [internet]. Washington (DC): The World Bank Group; 2015. [cited 2015 Mar 1]. Available from: <http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS?order=wbapi_data_valu...>.
    1. McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J, DeCristofaro A, Kerr EA. The Quality of Health Care Delivered to Adults in the United States. New Engl J Med 2003; 348: 2635–2645. - PubMed
    1. Blumenthal D, Tavenner M. The ‘Meaningful Use’ Regulation for Electronic Health Records. New Engl J Med 2010; 363: 501–504. - PubMed
    1. Moukheiber Z. The Staggering Cost Of An Epic Electronic Health Record Might Not Be Worth It. 2012 Jun 8 [cited 2015 Mar 31]. In: Forbes Business [Internet]. New York: Forbes; Available from: <http://www. forbes.com/sites/zinamoukheiber/2012/06/18/the-staggering-co...>.
    1. Mandl KD, Kohane IS. Escaping the EHR Trap –The Future of Health IT. New Engl J Med 2012; 366: 2240–2242. - PubMed

MeSH terms