University of Colorado Denver, Division of Emergency Medicine, Aurora, CO.
West J Emerg Med. 2010 Sep;11(4):329-32.
An electronic emergency department information system (EDIS) can monitor the progress of a patient visit, facilitate computerized physician order entry, display test results and generate an electronic medical record. Ideally, use of an EDIS will increase overall emergency department (ED) efficiency. However, in academic settings where new interns rotate through the ED monthly, the "learning curve" experienced by the new EDIS user may slow down patient care. In this study, we measured the impact of the "intern learning curve" on patient length of stay (LOS).
We retrospectively analyzed one year of patient care data, generated by a comprehensive EDIS in a single, urban, university-affiliated ED. Intern rotations began on the 23rd of each month and ended on the 22nd of the next month. Interns received a 1.5-hour orientation to the EDIS prior to starting their rotation; none had prior experience using the electronic system. Mean LOS (± standard error of the mean) for all patients treated by an intern were calculated for each day of the month. Values for similar numerical days from each month were combined and averaged over the year resulting in 31 discrete mean LOS values. The mean LOS on the first day of the intern rotation was compared with the mean LOS on the last day, using Student's t-test.
During the study period 9,780 patients were cared for by interns; of these, 7,616 (78%) were discharged from the ED and 2,164 (22%) were admitted to the hospital. The mean LOS for all patients on all days was 267 ± 1.8 minutes. There was no difference between the LOS on the first day of the rotation (263±9 minutes) and the last day of the rotation (276 ± 11 minutes, p > 0.9). In a multiple linear regression model, the day of the intern rotation was not associated with patient LOS, even after adjusting for the number of patients treated by interns and total ED census (β = -0.34, p = 0.11).
In this academic ED, where there is complete intern "turnover" every month, there was no discernible impact of the EDIS "learning curve" on patient LOS.
电子急诊信息系统（EDIS）可以监测患者就诊进度，方便计算机化医嘱录入，显示检验结果并生成电子病历。理想情况下，使用 EDIS 将提高急诊部（ED）的整体效率。然而，在学术环境中，新实习生每月在 ED 轮转，新 EDIS 用户的“学习曲线”可能会减缓患者护理速度。在这项研究中，我们测量了“实习生学习曲线”对患者住院时间（LOS）的影响。
我们回顾性分析了在一家城市大学附属医院的综合 ED 中生成的一年患者护理数据。实习生轮转于每月 23 日开始，下一个月 22 日结束。实习生在轮转前接受了 1.5 小时的 EDIS 介绍；他们都没有使用电子系统的先前经验。计算了每位实习生治疗的所有患者在每月的每一天的平均 LOS（±平均值的标准误差）。将每月相同数值的天数进行合并并平均，得出一年中 31 个离散的平均 LOS 值。使用学生 t 检验比较实习生轮转的第一天的平均 LOS 与最后一天的平均 LOS。
在研究期间，9780 名患者由实习生照顾；其中 7616 名（78%）从 ED 出院，2164 名（22%）住院。所有患者在所有日子的平均 LOS 为 267±1.8 分钟。在轮转的第一天（263±9 分钟）和最后一天（276±11 分钟，p>0.9）之间，LOS 没有差异。在多元线性回归模型中，即使在调整实习生治疗的患者数量和 ED 总人数后，实习生轮转的日子与患者 LOS 无关（β=-0.34，p=0.11）。
在这家学术 ED 中，每月都有完整的实习生“轮换”，EDIS“学习曲线”对患者 LOS 没有明显影响。
