4 Best Practices for Increasing Efficiency in Emergency Departments With Information Technology

John Fontanetta, chairman of the emergency department at Clara Maass Medical Center in Belleville, N.J. and CMO for EDIMS, discusses four ways to improve efficiency in an emergency department with information technology.

1. Resist the urge to implement in stages. EDs typically resist change for fear that it may impede the functions of the department, particularly when implementing electronic medical records. When deploying information systems in EDs, it's critical to go live with the systems in one step.

"The problem with implementing systems in EDs is you can't just choose to do it on a Sunday night," Dr. Fontanetta says. "You can't do that in an ED because it's a 24/7 operation. The best way to do it is to train the staff to be ready and then just flip the switch."

2. Have full commitment from administration.
One hundred percent commitment from hospital executive leaders ensures successful implementation of information systems is a priority. Dr. Fontanetta recalls a time when a hospital chose to implement a fast track information system, first testing the system outside of the ED before bringing it to that department. He says the project failed because the administration was unwilling to commit fully to making sure the project would succeed.

"Physicians using the technology stopped using the fast track because it was creating havoc, and the administration never had full commitment so the ED never committed to it," Dr. Fontanetta says.

3. Examine HIT usability vs. ER demands. EDs run very differently from other departments of a hospital. Given the fast-paced nature, needs and demands of the ED, it's important that the system fits ED operations and needs. This could mean customizing the number of screens an emergency physician would have to go through to pull up patient records or increasing ease of use when doing an order entry.

"Our electronic order entry is customized just for our ED because 95 percent of their orders are one-time orders," Dr. Fontanetta says. "In other areas of the hospital, medication is set on a schedule for patients. We understand what an ED physician needs and built our system in a way that will help them do their job."

4. Track data to find areas of improvement. Dr. Fontanetta says the ED prints monthly reports that tracks various data points such as door-to-triage time, which measures the time from which a patient enters the ED to the time they see an emergency physician.

"Based on these data points, we can find any problems," he says. "To drill down on door-to-triage time, we may find we need a greeter in the ED to facilitate the process but only at 3 p.m. because door-to-triage time is fine all night. We implement a remedy and observe closely within the next couple of weeks to see if that remedy worked."

Learn more about Clara Maass Medical Center.

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