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. 2017 Nov;70(5):674-682.e1.
doi: 10.1016/j.annemergmed.2017.05.032. Epub 2017 Jul 14.

A Custom-Developed Emergency Department Provider Electronic Documentation System Reduces Operational Efficiency

Joshua Feblowitz  1 , Sukhjit S Takhar  1 , Michael J Ward  2 , Ryan Ribeira  3 , Adam B Landman  4
Affiliations

A Custom-Developed Emergency Department Provider Electronic Documentation System Reduces Operational Efficiency

Joshua Feblowitz et al. Ann Emerg Med. 2017 Nov.

Abstract

Study objective: Electronic health record implementation can improve care, but may also adversely affect emergency department (ED) efficiency. We examine how a custom, ED provider, electronic documentation system (eDoc), which replaced paper documentation, affects operational performance.

Methods: We analyzed retrospective operational data for 1-year periods before and after eDoc implementation in a single ED. We computed daily operational statistics, reflecting 60,870 pre- and 59,337 postimplementation patient encounters. The prespecified primary outcome was daily mean length of stay; secondary outcomes were daily mean length of stay for admitted and discharged patients and daily mean arrival time to disposition for admitted patients. We used a prespecified multiple regression model to identify differences in outcomes while controlling for prespecified confounding variables.

Results: The unadjusted change in length of stay was 8.4 minutes; unadjusted changes in secondary outcomes were length of stay for admitted patients 11.4 minutes, length of stay for discharged patients 1.8 minutes, and time to disposition 1.8 minutes. With a prespecified regression analysis to control for variations in operational characteristics, there were significant increases in length of stay (6.3 minutes [95% confidence interval 3.5 to 9.1 minutes]) and length of stay for discharged patients (5.1 minutes [95% confidence interval 1.9 to 8.3 minutes]). There was no statistically significant change in length of stay for admitted patients or time to disposition.

Conclusion: In our single-center study, the isolated implementation of eDoc was associated with increases in overall and discharge length of stay. Our findings suggest that a custom-designed electronic provider documentation may negatively affect ED throughput. Strategies to mitigate these effects, such as reducing documentation requirements or adding clinical staff, scribes, or voice recognition, would be a valuable area of future research.

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Conflict of interest statement

Conflicts of Interest: None

Figures

Figure 1
Figure 1
Unadjusted outcomes by weekly average for one-year pre- and post-implementation periods. Outcomes include: mean length-of-stay (LOS), mean length-of-stay for admitted (LOSa) and discharged patients (LOSd), and mean time to disposition for admitted patients (TTD). Trendlines were generated by LOESS method.
Figure 2
Figure 2
Unadjusted outcomes by weekly average for eight week pre- and post-implementation periods. Outcomes include: mean length-of-stay (LOS), mean length-of-stay for admitted (LOSa) and discharged patients (LOSd), and mean time to disposition for admitted patients (TTD). Trendlines were generated by LOESS method.
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