253: Computerized Prescriber Order Entry Decreases Patient Satisfaction and Emergency Physician Productivity

Bastani, Aveh; Walch, R.; Todd, Brett; Dimsdale, S.; Donaldson, David; Dennis, Bradley M.; Bonanno, Daniela; Anderson, William C.

doi:10.1016/j.annemergmed.2010.06.302

Cited by 10 publications

(7 citation statements)

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“…Bastani et al evaluated scribe impacts on ED throughput and patient and provider satisfaction. 22 At their community site, scribes were implemented shortly after computerized-physician order entry (CPOE), which had worsened ED throughput; 28 scribes were an attempt to address these deficits. Evaluating the scribe program roughly three months after implementation, they found that the scribe program returned their flow metrics to the pre-CPOE baseline and, for certain metrics (time from seeing a provider to being admitted, LOS for admitted and discharged patients), there was an improvement beyond the baseline.…”

Section: Discussionmentioning

confidence: 99%

Scribe Impacts on Provider Experience, Operations, and Teaching in an Academic Emergency Medicine Practice

Hess¹,

Wallenstein²,

Ackerman³

et al. 2015

WestJEM

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IntroductionPhysicians dedicate substantial time to documentation. Scribes are sometimes used to improve efficiency by performing documentation tasks, although their impacts have not been prospectively evaluated. Our objective was to assess a scribe program’s impact on emergency department (ED) throughput, physician time utilization, and job satisfaction in a large academic emergency medicine practice.MethodsWe evaluated the intervention using pre- and post-intervention surveys and administrative data. All site physicians were included. Pre- and post-intervention data were collected in four-month periods one year apart. Primary outcomes included changes in monthly average ED length of stay (LOS), provider-specific average relative value units (RVUs) per hour (raw and normalized to volume), self-reported estimates of time spent teaching, self-reported estimates of time spent documenting, and job satisfaction. We analyzed data using descriptive statistics and appropriate tests for paired pre-post differences in continuous, categorical, and ranked variables.ResultsPre- and post-survey response rates were 76.1% and 69.0%, respectively. Most responded positively to the intervention, although 9.5% reported negative impressions. There was a 36% reduction (25%–50%; p<0.01) in time spent documenting and a 30% increase (11%–46%, p<0.01) in time spent in direct patient contact. No statistically significant changes were seen in job satisfaction or perception of time spent teaching. ED volume increased by 88 patients per day (32–146, p=0.04) pre- to post- and LOS was unchanged; rates of patients leaving against medical advice dropped, and rates of patients leaving without being seen increased. RVUs per hour increased 5.5% and per patient 5.3%; both were statistically significant. No statistically significant changes were seen in patients seen per hour. There was moderate correlation between changes in ED volume and changes in productivity metrics.ConclusionScribes were well received in our practice. Documentation time was substantially reduced and redirected primarily to patient care. Despite an ED volume increase, LOS was maintained, with fewer patients leaving against medical advice but more leaving without being seen. RVUs per hour and per patient both increased.

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Section: Discussionmentioning

confidence: 99%

Scribe Impacts on Provider Experience, Operations, and Teaching in an Academic Emergency Medicine Practice

Hess¹,

Wallenstein²,

Ackerman³

et al. 2015

WestJEM

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“…Not only should long‐term consequences be evaluated, but so should the implementation process. For example, there is a lack of rigorously performed, multicenter studies examining the effect on ED operations of tracking system, EHR, and CPOE implementation and use 76–80 . Reliable means to measure these effects and to identify contributing factors must be developed and utilized consistently.…”

Section: How Do Ed Design Patient Flow Structures and Use Of Tecmentioning

confidence: 99%

Achieving Efficiency in Crowded Emergency Departments: A Research Agenda

Ward¹,

Farley²,

Khare³

et al. 2011

Academic Emergency Medicine

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In 2011, Academic Emergency Medicine convened a consensus conference entitled ''Interventions to Assure Quality in the Crowded Emergency Department.'' This article, a product of the breakout session on ''interventions to safeguard efficiency of care,'' explores various elements of the research agenda on efficiency and quality in crowded emergency departments (EDs). The authors discuss four areas identified as critical to achieving progress in the research agenda for improving ED efficiency: 1) What measures can be used to understand and improve the efficiency and quality of interventions in the ED? 2) Which factors outside of the ED's control affect ED efficiency? 3) How do workforce factors affect ED efficiency? 4) How do ED design, patient flow structures, and use of technology affect efficiency? Filling these knowledge gaps is vital to identifying interventions that improve the delivery of emergency care in all EDs.

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“…Studied clinical benefits of CPOE include reduced prescribing errors and adverse medication interactions, 6 improved adherence to evidence-based protocols for specific presentations, such as renal colic and acute ischemic stroke, [7][8][9] increased legibility and accessibility of documentation on record, 10 and potential secondary uses of data by health care organizations for outcome tracking and quality assessment. 10 CPOE's benefits, however, may come at the cost of decreased patient and physician satisfaction, 11,12 impaired emergency physician productivity, 13 and increased length of stay (LOS) in the emergency department (ED) for admitted patients. 14 There is no strong evidence to suggest that CPOE improves patient mortality, 15 and the literature has not yet provided consensus evidence in favour of CPOE when weighing its benefits and drawbacks.…”

Section: Introductionmentioning

confidence: 99%

SGEM Hot Off the Press: Computer provider order entry (CPOE) and emergency department flow

Lin

Chan

Mohindra

et al. 2017

CJEM

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As part of the Canadian Journal of Emergency Medicine (CJEM) developing social media strategy, 1 we are collaborating with the Skeptics' Guide to Emergency Medicine (SGEM) to summarize and critically appraise the current emergency medicine literature using evidence-based medicine principles. In the Hot Off the Press (HOP) series, we select original research manuscripts published in CJEM to be summarized and critically appraised on the SGEM website/podcast 2 and discussed by the study authors and the online EM community. A similar collaboration is underway between the SGEM and Academic Emergency Medicine. What follows is a summary of the selected article and the immediate post-publication critical appraisal from the SGEM podcast, as well as an overview of the subsequent discussion from the SGEM blog and other social media. Through this series, we hope to enhance the value, accessibility, and application of important, clinically relevant EM research. In this, the fourth SGEM HOP hosted collaboratively with CJEM, we discuss Gray et al.'s paper 3 evaluating the impact of computerized provider order entry on patient flow through a quaternary emergency department in London, Ontario.

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253: Computerized Prescriber Order Entry Decreases Patient Satisfaction and Emergency Physician Productivity

Cited by 10 publications

References 0 publications

Scribe Impacts on Provider Experience, Operations, and Teaching in an Academic Emergency Medicine Practice

Scribe Impacts on Provider Experience, Operations, and Teaching in an Academic Emergency Medicine Practice

Achieving Efficiency in Crowded Emergency Departments: A Research Agenda

SGEM Hot Off the Press: Computer provider order entry (CPOE) and emergency department flow

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