Lo Mark D, Rutman Lori E, Migita Russell T, Woodward George A
From the Pediatrics, University of Washington, and Pediatric Emergency Medicine, Seattle Children's Hospital, Seattle, WA.
Pediatr Emerg Care. 2015 Nov;31(11):798-804. doi: 10.1097/PEC.0000000000000600.
Many emergency departments are transitioning from paper charting to full electronic health records, which include both computerized provider order entry and provider documentation. Implementation of electronic provider documentation (EPD), in particular, has been challenging. Known benefits include legibility, medicolegal and compliance safeguards, and improved access to patient charts. Offsetting these benefits may be reductions in efficiency, patient throughput, and less provider-patient interaction.
We used a rapid design process coupled with Lean principles, simulation, aggressive training, and continuous process improvement to design and implement a novel EPD system with real-time voice recognition dictation in the pediatric emergency department (PED). We used statistical process control methodologies to compare mean PED lengths of stay (LOSs) for admitted and discharged patients before and after EPD GoLive.
We were able to design, test, train, and implement a novel EPD to the PED within 7 months. There was special cause variation, with a 2.7% (5-minute) increase in overall LOS after EPD implementation. There was a temporary 9.3% (15-minute) increase in discharge LOS for 6 weeks after GoLive, with a subsequent return to a new baseline of 4.3% (7-minute) increase. There were no significant changes in admission LOS. There was overall consistent use of the voice recognition system several months after EPD rollout. There have been improving rates of compliance with chart completion over time, as a result of easier tracking and electronic reminders to complete.
Despite the inherent challenges involved in transitioning from paper charting to EPD, our study showed that an academic ED, EPD, can be rapidly designed and implemented while not significantly negatively impacting ED metrics such as LOS. We had consistent use of the voice dictation system after implementation. Time spent documenting after clinical shift was not reliably captured and is an important area of future research for successful EPD implementation.
许多急诊科正在从纸质病历过渡到全面的电子健康记录，其中包括计算机化医嘱录入和医生文档记录。特别是电子医生文档记录（EPD）的实施一直具有挑战性。已知的好处包括字迹清晰、法律和合规保障以及改善病历获取。但这些好处可能会被效率降低、患者周转率下降以及医患互动减少所抵消。
我们采用了快速设计流程，并结合精益原则、模拟、强化培训和持续流程改进，在儿科急诊科（PED）设计并实施了一种具有实时语音识别听写功能的新型EPD系统。我们使用统计过程控制方法比较了EPD上线前后入院和出院患者的平均PED住院时间（LOS）。
我们能够在7个月内为PED设计、测试、培训并实施一种新型EPD。存在特殊原因变异，EPD实施后总体LOS增加了2.7%（5分钟）。上线后6周，出院LOS暂时增加了9.3%（15分钟），随后恢复到新基线，增加了4.3%（7分钟）。入院LOS没有显著变化。EPD推出几个月后，语音识别系统的使用总体上保持一致。随着跟踪变得更容易以及有电子提醒来完成，随着时间的推移，病历完成的合规率一直在提高。
尽管从纸质病历过渡到EPD存在内在挑战，但我们的研究表明，一个学术性急诊科的EPD可以快速设计和实施，同时不会对诸如LOS等急诊科指标产生显著负面影响。实施后我们对语音听写系统的使用保持一致。临床轮班后记录所花费的时间没有得到可靠记录，这是未来成功实施EPD的一个重要研究领域。
