- Email: [email protected]
The Workload and Efficiency of Nursing Assistants Trained to Work As Emergency Transfer Liaisons
Research Forum Abstracts information and chief complaint at various locations in the ED, as well as their overall level of privacy. We categorized the seven locations in our ED where patients are routinely asked for PHI as Private (triage room with closed door, private treatment room, and shared treatment room without another patient) or Non-Private (triage window, triage desk, triage room with open door, and shared treatment room with another patient). Results: We accounted for every patient in the ED during the hours of data collection and received surveys back from 209 patients. Patients were more comfortable giving their name, SSN, insurance information and chief complaint in a Private versus Non-Private setting (p\0.01 for all). Patients rated their overall level of privacy with respect to their PHI higher if they were in a triage room with a closed door versus an open door (p\0.01) and if they were in a treatment room that was Private versus Non-Private (p=0.02). Patients who were cared for exclusively in a Private setting during their entire ED visit were more satisfied with the privacy of their PHI when compared to patients who had any breach in their privacy (p\0.01). Conclusions: Patients are more comfortable giving all aspects of PHI in settings with closed doors and in private rooms, and their overall level of privacy was higher if they spent some or all of their time in a private setting.
18
Feasibility of an Electronic Medical Record and Its Impact on Emergency Department Length of Stay
Boie ET, Mayo Clinic, Rochester, MN
Objective: To determine the feasibility of implementing an Electronic Medical Record (EMR) in a large teaching hospital and study the initial impact on emergency department (ED) length of stay (LOS). Methods: This study was conducted at a tertiary referral academic medical center with an annual ED census of 77,000 in the upper Midwest. The EMR was implemented live on March 1st, 2005, after 120 hours of nurse training (the heaviest users of the EMR) and 1 hour of physician training (the physician note is dictated and transcribed within 30 minutes into the EMR). Electronic feedback with regard to advantages and disadvantages of the EMR was requested of all users. The LOS was prospectively recorded for the first 3 weeks in March (control period) and then again in the first 3 weeks of April (study period), with the idea that facility and familiarity with the EMR would likely affect overall LOS. Results: The volumes of patients seen during the control and study periods were comparable (3337 versus 3482). The overall LOS in the control period, when the EMR was first implemented, was 202 minutes. The LOS fell to 190 minutes in the subsequent month, likely due to increased facility with the computer by the users. This represents a decrease of 12 minutes per patient, despite the volume being slightly higher during the study period. For historical comparison, the overall LOS was obtained for patients seen in March and April of 2004. A total of 6317 patients were seen, for an average LOS of 170 minutes. Implementation of the EMR resulted in a 16% increase in LOS in minutes, or an absolute increase of 32 minutes, which falls below the national benchmark of 40 minutes. Documented advantages of the EMR included: Ability to manage resident flow: the EMR allows the provider to view in a single snapshot all areas of the ED, so that residents can be more easily distributed to areas that need the most manpower; Enhanced follow-up of patients: the EMR has a ‘‘hotlist’’ screen on which a physician can drag the name of a patient they want to follow up. This then becomes a live link to that specific patient’s medical record (even if that patient is no longer in the ED). Ability to view primary care info easily (the EMR screen allows for viewing of problem list and immunizations, speeding up patient throughput) Documented disadvantages of the EMR include: Time required to input into computer takes time away from the patient; Using the EMR takes getting used to. Conclusions: Implementation of an EMR in a busy ED is feasible. Initially the implementation will increase LOS, but this increase is temporary, with evidence of downward trend apparent in the first month itself.
19
Patients’ Perception of Privacy During Various Phases of Emergency Care
McKenna DP, Triner W, Kardos K, McErlean M, Albany Medical Center Hospital, Albany, NY
Study Objectives: The purpose of this study was to determine the degree to which patients feel personal health information (PHI) privacy was compromised during various stages of care in the Emergency Department (ED). Methods: This was a cross sectional, observational survey-based study of a consecutive sample of patients presenting through triage. Patients were approached at the end of their ED visit and asked to complete the survey. All hours of the day were equally represented. Patients scored on a 5-point Likert scale the level of privacy they experienced in giving their name, Social Security Number (SSN), insurance
Volume 46, no. 3 : September 2005
20
The Workload and Efficiency of Nursing Assistants Trained to Work As Emergency Transfer Liaisons
McKenna DP, Triner W, McErlean M, Stern M, Albany Medical Center Hospital, Albany, NY
Study Objectives: The purpose of this study was to quantify the workload and efficiency of Nursing Assistants (NAs) trained to work as Emergency Transfer Liaisons (ETLs) in our emergency department (ED). Methods: We initiated a pilot program of using NAs in the role of ETLs. The ETLs were instructed on how to communicate with referring physicians; coordinate with specialists, bed access and ED personnel; and arrange for transfers. They kept a quality assurance dataset on every potential transfer they handled. The ETLs were physically located in the ED. Our ED is a Level I trauma center with an annual census of 65,000. The study data was observed from all potential transfers during the hours the ETLs worked over 183 days. The method of sampling was consecutive. Results: The ETLs handled 2145 potential transfers. There was an average of 11.7 potential transfers per day (range 3-23). The time required for each transfer request included the time spent on the phone, coordinating with in-house personnel, and entering the pre-arrival information into our computerized patient tracker. Each potential transfer required an average of 2.5 phone calls (range 1-23) and 16.5 minutes (range 1-150). The ETLs spent an average of 193 minutes a day (range 30495) coordinating transfers, and 82.5% of transfer requests from regional EDs were accepted. During the first 30 days of the program the ED attending needed to speak to the referring physician 20.4% of the time, but during the last 30 days this number had dropped to 7.9%. Overall, during the course of the program the ETLs needed phone intervention by our ED attending physician only 8.6% of the time. Conclusions: Our pilot program demonstrates that NAs can be used as ETLs in an ED with many transfer requests. The ETLs were able to facilitate transfers for the greater majority of requests. The ETLs needed phone intervention by our ED attending less often during the course of the program.
21
Critical Care Responsibilty in Community Emergency Medicine Practice: Results of an Emergency Department Director Survey
Sherwin R, Bilkovski R, Henry Ford Hospital, Detroit, MI
Study Objectives: Emergency physicians (EPs) that practice in the community often have additional clinical responsibilities that include responding to floor codes and unstable ICU patients. This study sought to obtain descriptive data regarding the critical care responsibility that community EPs shoulder outside of their department. Methods: A one page survey was mailed to Emergency Department Directors (EDDs)in 10 states and the District of Columbia. The survey addressed ED/hospital demographics, EP responsibilities to respond to medical floor arrests and unstable ICU patients. Interest in hiring dual boarded EM/Critical Care EPs was also queried. Statistical analysis included descriptive statistics, independent t-test as well as chi-square analysis. Statistical significance was defined at p=0.05. Results: 319 of 1169 surveys were returned. EDDs identified themselves as urban, suburban or rural 20, 34 and 42% of the time respectively; 3% did not disclose. EDDs reported that 76% (n=244) of their institutions require EPs to leave their emergency department and respond to medical codes/arrests after hours; in 73%(n=179) of these institutions, the EP was the only physician required to respond. Hospitals in which EPs were required to respond to medical codes were smaller in
Annals of Emergency Medicine S7
18
Feasibility of an Electronic Medical Record and Its Impact on Emergency Department Length of Stay
Boie ET, Mayo Clinic, Rochester, MN
Objective: To determine the feasibility of implementing an Electronic Medical Record (EMR) in a large teaching hospital and study the initial impact on emergency department (ED) length of stay (LOS). Methods: This study was conducted at a tertiary referral academic medical center with an annual ED census of 77,000 in the upper Midwest. The EMR was implemented live on March 1st, 2005, after 120 hours of nurse training (the heaviest users of the EMR) and 1 hour of physician training (the physician note is dictated and transcribed within 30 minutes into the EMR). Electronic feedback with regard to advantages and disadvantages of the EMR was requested of all users. The LOS was prospectively recorded for the first 3 weeks in March (control period) and then again in the first 3 weeks of April (study period), with the idea that facility and familiarity with the EMR would likely affect overall LOS. Results: The volumes of patients seen during the control and study periods were comparable (3337 versus 3482). The overall LOS in the control period, when the EMR was first implemented, was 202 minutes. The LOS fell to 190 minutes in the subsequent month, likely due to increased facility with the computer by the users. This represents a decrease of 12 minutes per patient, despite the volume being slightly higher during the study period. For historical comparison, the overall LOS was obtained for patients seen in March and April of 2004. A total of 6317 patients were seen, for an average LOS of 170 minutes. Implementation of the EMR resulted in a 16% increase in LOS in minutes, or an absolute increase of 32 minutes, which falls below the national benchmark of 40 minutes. Documented advantages of the EMR included: Ability to manage resident flow: the EMR allows the provider to view in a single snapshot all areas of the ED, so that residents can be more easily distributed to areas that need the most manpower; Enhanced follow-up of patients: the EMR has a ‘‘hotlist’’ screen on which a physician can drag the name of a patient they want to follow up. This then becomes a live link to that specific patient’s medical record (even if that patient is no longer in the ED). Ability to view primary care info easily (the EMR screen allows for viewing of problem list and immunizations, speeding up patient throughput) Documented disadvantages of the EMR include: Time required to input into computer takes time away from the patient; Using the EMR takes getting used to. Conclusions: Implementation of an EMR in a busy ED is feasible. Initially the implementation will increase LOS, but this increase is temporary, with evidence of downward trend apparent in the first month itself.
19
Patients’ Perception of Privacy During Various Phases of Emergency Care
McKenna DP, Triner W, Kardos K, McErlean M, Albany Medical Center Hospital, Albany, NY
Study Objectives: The purpose of this study was to determine the degree to which patients feel personal health information (PHI) privacy was compromised during various stages of care in the Emergency Department (ED). Methods: This was a cross sectional, observational survey-based study of a consecutive sample of patients presenting through triage. Patients were approached at the end of their ED visit and asked to complete the survey. All hours of the day were equally represented. Patients scored on a 5-point Likert scale the level of privacy they experienced in giving their name, Social Security Number (SSN), insurance
Volume 46, no. 3 : September 2005
20
The Workload and Efficiency of Nursing Assistants Trained to Work As Emergency Transfer Liaisons
McKenna DP, Triner W, McErlean M, Stern M, Albany Medical Center Hospital, Albany, NY
Study Objectives: The purpose of this study was to quantify the workload and efficiency of Nursing Assistants (NAs) trained to work as Emergency Transfer Liaisons (ETLs) in our emergency department (ED). Methods: We initiated a pilot program of using NAs in the role of ETLs. The ETLs were instructed on how to communicate with referring physicians; coordinate with specialists, bed access and ED personnel; and arrange for transfers. They kept a quality assurance dataset on every potential transfer they handled. The ETLs were physically located in the ED. Our ED is a Level I trauma center with an annual census of 65,000. The study data was observed from all potential transfers during the hours the ETLs worked over 183 days. The method of sampling was consecutive. Results: The ETLs handled 2145 potential transfers. There was an average of 11.7 potential transfers per day (range 3-23). The time required for each transfer request included the time spent on the phone, coordinating with in-house personnel, and entering the pre-arrival information into our computerized patient tracker. Each potential transfer required an average of 2.5 phone calls (range 1-23) and 16.5 minutes (range 1-150). The ETLs spent an average of 193 minutes a day (range 30495) coordinating transfers, and 82.5% of transfer requests from regional EDs were accepted. During the first 30 days of the program the ED attending needed to speak to the referring physician 20.4% of the time, but during the last 30 days this number had dropped to 7.9%. Overall, during the course of the program the ETLs needed phone intervention by our ED attending physician only 8.6% of the time. Conclusions: Our pilot program demonstrates that NAs can be used as ETLs in an ED with many transfer requests. The ETLs were able to facilitate transfers for the greater majority of requests. The ETLs needed phone intervention by our ED attending less often during the course of the program.
21
Critical Care Responsibilty in Community Emergency Medicine Practice: Results of an Emergency Department Director Survey
Sherwin R, Bilkovski R, Henry Ford Hospital, Detroit, MI
Study Objectives: Emergency physicians (EPs) that practice in the community often have additional clinical responsibilities that include responding to floor codes and unstable ICU patients. This study sought to obtain descriptive data regarding the critical care responsibility that community EPs shoulder outside of their department. Methods: A one page survey was mailed to Emergency Department Directors (EDDs)in 10 states and the District of Columbia. The survey addressed ED/hospital demographics, EP responsibilities to respond to medical floor arrests and unstable ICU patients. Interest in hiring dual boarded EM/Critical Care EPs was also queried. Statistical analysis included descriptive statistics, independent t-test as well as chi-square analysis. Statistical significance was defined at p=0.05. Results: 319 of 1169 surveys were returned. EDDs identified themselves as urban, suburban or rural 20, 34 and 42% of the time respectively; 3% did not disclose. EDDs reported that 76% (n=244) of their institutions require EPs to leave their emergency department and respond to medical codes/arrests after hours; in 73%(n=179) of these institutions, the EP was the only physician required to respond. Hospitals in which EPs were required to respond to medical codes were smaller in
Annals of Emergency Medicine S7