Ravi Akshay, Shochat Guy, Wang Ralph C, Khanna Raman
Department of Medicine University of California San Francisco California USA.
Department of Emergency Medicine University of California San Francisco California USA.
J Am Coll Emerg Physicians Open. 2023 Mar 21;4(2):e12922. doi: 10.1002/emp2.12922. eCollection 2023 Apr.
Subspecialty consultation in the emergency department (ED) is a vital, albeit time consuming, part of modern medicine. Traditional consultation requires manual paging to initiate communication. Although consult orders through the electronic health record (EHR) may help, they do not facilitate 2-way communication. However, the impact of combining these systems within the EHR is unknown. We estimated the effect of implementing an integrated paging system on ED workflow efficiency and user attitudes.
We integrated a messaging system into order entry at our tertiary care academic ED, such that placing a consult order simultaneously paged the consultant. We measured ED workflow efficiency metrics (length of stay [LOS], consult initiation time) and MD/nurse practitioner (NP)/physician assistant (PA) attitudes (perceived mis-pages, efficiency, and workflow preference) 3 months before and 6 months after the implementation.
Six months after implementation, there was 25% use of the new workflow. During the pre-implementation phase, the median time to consult initiation and ED LOS were 150 and 621 minutes, respectively. Implementation of the order was associated with a 15-minute reduction in median time to consult initiation ( < 0.001), and a 52-minute reduction in median ED LOS ( < 0.001). ED MDs/NPs/PAs perceived a reduction in the rate of mis-pages, improved efficiency, and overall preferred the new workflow.
We consolidated steps in the ED consult workflow using an integrated consult order, which improved user satisfaction, and reduced consult initiation time and ED LOS for patients requiring a consult at an urban tertiary care ED.
急诊科的专科会诊是现代医学中至关重要的一部分，尽管耗时较长。传统会诊需要人工传呼来启动沟通。虽然通过电子健康记录（EHR）下达会诊医嘱可能会有所帮助，但它们无法促进双向沟通。然而，在电子健康记录中整合这些系统的影响尚不清楚。我们评估了实施集成传呼系统对急诊科工作流程效率和用户态度的影响。
我们在三级医疗学术急诊科的医嘱录入中集成了一个消息系统，这样下达会诊医嘱时会同时传呼会诊医生。我们在实施前3个月和实施后6个月测量了急诊科工作流程效率指标（住院时间[LOS]、会诊启动时间）以及医生/执业护士（NP）/医师助理（PA）的态度（感知到的误传呼、效率和工作流程偏好）。
实施6个月后，新工作流程的使用率为25%。在实施前阶段，会诊启动的中位时间和急诊科住院时间分别为150分钟和621分钟。该医嘱的实施使会诊启动的中位时间减少了15分钟（<0.001），急诊科住院时间的中位时间减少了52分钟（<0.001）。急诊科医生/执业护士/医师助理认为误传呼率降低、效率提高，总体上更喜欢新的工作流程。
我们使用集成会诊医嘱整合了急诊科会诊工作流程中的步骤，这提高了用户满意度，并减少了会诊启动时间以及城市三级医疗急诊科中需要会诊的患者的住院时间。
