System puts information at your fingertips
Previous medical records available
Thanks to a unique information system developed by ED physicians, staff can see a patient’s lab test results or X-rays from a current or previous ED visit with a single click, reports Craig Feied, MD, FACEP, FAAEM, director of informatics for Washington (DC) Hospital Center, one of the EDs where the system is used. Feied co-developed the system. "We can also see what medications were given, how long they were here, and what prescriptions were filled," he says.
Here are three ways in which the system provides easy access to patient information:
1. Patients’ previous medical records are available.
One patient, who was intoxicated, came in with a seizure. His previous ED visits showed that he had been seen before for seizures and drug abuse. "The clinician normally would be tempted to assume it was a repeat seizure disorder and not give the patient a complete work-up," says Feied. "However, with one click, we had access to every single diagnosis and procedure this patient had in our hospital since 1992."
It turned out that the patient had a previous intercranial bleed and an aneurysm. "Suddenly the story was very different: The patient was having seizures because of an anatomical medical problem, and he also happens to drink. He had another CAT scan and recurrent bleeding in the brain and had brain surgery as a result. Without it, he most likely would have been sent home and died a couple days later," Feied says.
2. Lab results are available as soon as they are ready.
The system offers a shortcut to obtaining lab results, which can cause significant delays. "Under the best of circumstances, stat labs take a half hour or an hour. And even when they do come back, they can get lost," he says. "This is a shortcut because it bypasses everything and is a direct conduit between the doctor and the data."
When lab results came back in two minutes for a patient being treated in the ED for congestive heart failure, they were flagged for extremely elevated potassium levels. "That was something that had not been suspected. The patient went into cardiac arrest just about the same moment the lab results came back," he says.
Previously, the patient most likely would have died because the underlying cause would not have been suspected, Feied notes. "The patient didn’t have a history of renal failure or anything that would make you look for that. We would have thought he was having a heart attack. But because we knew the cardiac problem was coming from high potassium, we treated that instead. In this case, the patient was resuscitated and did fine," he recalls.
With other systems, pulling up lab results requires bypassing multiple screens with other systems, notes Therese Pearrell, RN, MSN, director of the ED at Washington Hospital Center. "You may need to go through several screens to get to the patient’s lab result. But with this, you just click on the patient’s name and can print a hard copy," she says.
Also, labs can be printed on a single sheet of paper. "So if a patient comes in who is hemodynamically unstable, I can marry it with the chart I’m sending with the patient upstairs to the cath lab, ICU, or wherever they’re being transferred," she says. "Other wise, you may have to print several screens from hematology or chemistry."
3. Delays in obtaining information are reduced.
The system has allowed the ED to absorb a 30% increase in volume without adding additional staff, reports Feied. "It’s cut our throughput time dramatically so that nearly 70% of our patients are seen and discharged within two hours."
When he and a colleague studied physician activity in the ED, they concluded that only a minority of physician time was spent in direct patient care activities. "About 60% of a clinician’s time was actually spent seeking, acquiring, and recording information," he says.
Often, that information is difficult to obtain, he says. "It might be in the patient’s old chart, or you may need to wait for lab results or go to a mainframe to look up. This way, all the information comes to one spot and is always there within 10 or 20 seconds of the time the information exists. Before the patient even comes back from X-ray, we have the image and the radiologist’s reading on our screen."
Waits are shorter because ED staff have a better awareness of what’s going on in other areas. "It used to be if we couldn’t physically see something, we wouldnt be aware of it," he says. "We can now see that registration is getting behind, so a supervisor can come out and cover that."
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