Patient Flow Enewsletter
Volume 1, Issue 3
Thursday, February 26, 2004
Today's world of information technology (IT) marvels has revolutionized modern medicine. The integration of computers, new medical devices, and networks has allowed health care providers to better gather patient data, organize, and analyze it more efficiently and use it to ultimately improve patient care.
Technology can also serve as a resource in combating emergency department crowding and throughput issues. In August 2003, the University of California - San Diego Medical Center implemented a series of IT changes designed to help address these very concerns, under the direction of Ted Chan, M.D., associate professor of clinical medicine in the department of emergency medicine, as part of the Urgent Matters program.
These initiatives were tested during the busiest hours of the ED, from 10:00 a.m. - 10:00 p.m. They included a rapid entry system, an open bed policy, and accelerated care at triage.
See slides on initiatives and IT requirementsNew Link
Implementation
The first step was coalescing the two computer registration systems (one for the Medical Center, and one for the ED). By combining records, Dr. Chan made several discoveries. "We found that 80 percent of our patients had been in the system before, and that some sort of 'quick registration' system would work for the remaining 20 percent," he said.
The quick registration system registered all patients under a simplified records system that assigned them a medical record number (required to receive care in triage).
"We were able to gather data that let us track the whole process," said Dr. Chan. "The data were there, but we were never able to look at it holistically." The registration process, which originally involved several lengthy steps and three separate wristbands, was then consolidated.
See new improvements in process.
"Now patients are given one wrist band on ED arrival and sign-in, before full registration, which has a bar code on it containing all of their information," said Dr. Chan.
Impact
Since Dr. Chan's team began, they have seen dramatic improvements in throughput time and patient numbers. Wait time for patients seeking admittance to the ED dropped almost 50 percent from July to October of 2003 (from 90 minutes to 45 minutes). Additionally, the ED was able to reduce the number of patients who left without receiving care from 9 percent to 3 percent.
The technology side of this improvement was only half of the challenge, however. "IT laid the foundation for this, but the culture change was the most challenging part," said Dr. Chan. Clerks needed to get used to the idea of searching for previous patient records at sign-in; nurses needed to learn to control the flow into the ED, and to prioritize putting patients in beds.
"You can have all of the IT systems you want, but people need to embrace the process," he said. "We wanted to try it, but we needed to show the benefit to the team."
The team at the Medical Center continues to make progress with its IT improvement initiative. "The next step is an electronic requisition system that allows us to access laboratory services and radiology more quickly," said Dr. Chan. Under the new system, the lab could receive orders in real-time, and the specimens would be bar-coded to reduce paperwork. This, in turn, would cut lab turnaround time significantly and reduce the total length of stay for all patients.
Dr. Chan credits excitement from the Urgent Matters program with creating some level of buy-in from staff, but also points to a long transition process as a potential pitfall. "We've had clerks using the new registration program for six months, and things are going well, but we can still improve how our staff maximize our IT capabilities," said Dr. Chan.
------------------------------------------------
Ted Chan, M.D.
Associate Professor of Clinical Medicine
Department of Emergency Medicine
University of California, San Diego
