Emergency care suffers during an EHR transition

Here's more proof that the move to electronic health records can be tougher than anticipated: it can slow down the emergency department's response time, which could impact patient care.

That's the scoop from a study published in the Journal of the American Medical Informatics Association last week, which was conducted by the Cincinnati Children's Hospital Medical Center (CCHMC). After transitioning its emergency department to a new EHR system in late 2009 and, CCHMC officials were concerned that the process would affect ED operations, according to the study. The ED already was struggling with patient crowding, low employee staffing and multiple interruptions.

CCHMC tried to reduce the chances that the transition would affect patient care by increasing both physician and nursing staffing during the process. The hospitals also implemented a strategy it had found successful during its handling of the H1N1 flu pandemic two months prior--it used an overflow clinic separate from the ED for low acuity patients.

The strategies didn't help much. Despite the proactive measures, the ED operated at 80 percent efficiency in terms of length of stay (LOS) in the ED during the two week transition period. The LOS for admitted patients was 6 to 20 percent longer during the transition; LOS for discharged patients was 12 to 22 percent longer than normal. "The impact for the delays in care was directly related to the implementation of EHR," the study's authors said.

Luckily, the slowdown appeared to be temporary; within three to four weeks, the ED was back at 90 percent efficiency, and at its baseline levels after three months.

The authors hope that these results will serve as a learning tool. "This should help other hospital/ED groups recognize potential needs when planning an EHR implementation," they said.

To learn more:
- read the study (.pdf)
- here's the CMIO article