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首页> 外文期刊>Joint Commission Journal on Quality and Safety >Clinical Information System and Process Redesign Improves Emergency Department Efficiency
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Clinical Information System and Process Redesign Improves Emergency Department Efficiency

机译：临床信息系统和流程的重新设计提高了急诊部门的效率

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Background: Fueled by a decade-long increase in emergency department (ED) visits with a concomitant decrease in hospital bed capacity and the number of hospital EDs, ED crowding has reached crisis proportions. Robust information systems and process redesign are two strategies to improve the safety and quality of emergency care. At the ED at the Mount Sinai Medical Center, an urban, tertiary care academic medical center in New York City, elements of departmental work flow were redesigned to streamline patient throughput before implementation of a fully integrated emergency department information system (EDIS) with patient tracking, computerized charting and order entry, and direct access to patient historical data from the hospital data repository. Pre- and postintervention data were analyzed to examine the impact on (ED) efficiency. Results: The length of stay for all patients (arrival to time patient left ED) decreased by 1.94 hours, from 6.69 (n = 508) pre-intervention to 4.75 (n = 691) postintervention (p < .001); doctor-to-disposition time (first doctor-patient contact to disposition decision) decreased by 1.90 hours, from 3.64 (n = 508) to 1.74 (n = 691; p < .001); door-to-doctor time (triage to first doctor-patient contact) decreased by 0.54 hours, from 1.22 (n = 508) to 0.68 (n = 691; p < .001). X-ray turnaround time (TAT) decreased by 0.18 hours from 0.92 (m = 60) to 0.74 (n = 108; p = .179); computerized tomography (CT) scan TAT decreased by 1.56 hours, from 3.89 (n = 40) to 2.33 (n = 29; p< .001), lab TAT decreased by 0.59 hours, from 2.03 (n = 121) to 1.44 (n = 271;p = .006).rnConclusions: Increasing the clinical information available at the bedside and improving departmental work flow through EDIS implementation and process redesign led to decreased patient throughput times and improved ED efficiency.
机译：背景：急诊科（ED）访问量增加了十年之久，医院病床容量和医院急诊室数量随之减少，导致急诊室拥挤已达到危机的程度。强大的信息系统和流程重新设计是提高急诊服务安全性和质量的两种策略。在纽约市的城市三级医疗学术医疗中心西奈山医疗中心的急诊室，在实施具有患者跟踪功能的完全集成的急诊科信息系统（EDIS）之前，对部门工作流程的要素进行了重新设计，以简化患者的工作量。 ，计算机化图表和订单输入，并可以直接从医院数据存储库访问患者历史数据。分析干预前后的数据，以检查对（ED）效率的影响。结果：所有患者的住院时间（到达左ED的时间）减少了1.94小时，从干预前的6.69（n = 508）降至干预后的4.75（n = 691）（p <.001）；医生到处置时间（首次医患接触决定处置时间）减少了1.90小时，从3.64（n = 508）减少到1.74（n = 691； p <.001）；门诊时间（首次与医患接触的时间）减少了0.54小时，从1.22（n = 508）减少到0.68（n = 691； p <.001）。 X射线周转时间（TAT）从0.92（m = 60）减少到0.74（n = 108; p = .179）减少了0.18小时。计算机断层扫描（CT）扫描的TAT减少了1.56小时，从3.89（n = 40）降低到2.33（n = 29； p <.001），实验室TAT减少了0.59小时，从2.03（n = 121）降低到1.44（n = 271； p = .006）。结论：通过EDIS实施和流程重新设计，增加床边可用的临床信息并改善部门工作流程，从而减少了患者的通行时间并提高了ED效率。

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    Kevin M. Baumlin; Jason S. Shapiro; Corey Weiner; Brett Gottlieb; Neal Chawla; Lynne D. Richardson;

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    Division of Informatics, is Associate Professor and Vice Chairman for Operations, Department of Emergency Medicine, Mount Sinai School of Medicine (MSSM), New York City;

    Division of Informatics, MSSM, Department of Emergency Medicine, and Postdoctoral Research Scientist, Department of Biomedical Informatics, Columbia University, New York City, is Director, Division of Informatics, MSSM, Department of Emergency Medicine;

    Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York;

    University of Michigan, Ann Arbor;

    Department of Emergency Medicine, INOVA Fairfax Hospital, Falls Church, Virginia;

    Department of Emergency Medicine, MSSM;

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