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Workflow/ Emergency Department abstracts

I've asked a secretary back at Utah to obtain number 2&3... should have them within a couple days. --Mpoynton 23:32, 10 June 2007 (MDT)

1: AMIA Annu Symp Proc. 2006;:926.

Analyzing workflow in emergency departments to prepare for health information exchange.

Friedmann BE, Shapiro JS, Kannry J, Kuperman G.

Department of Biomedical Informatics, Columbia University, New York, NY 10032, USA.

The New York Clinical Information Exchange (NYCLIX) was established to facilitate data sharing across 14 organizations. Workflow evaluations were conducted to identify mechanisms by which clinicians could be informed of NYCLIX data in the Emergency Department (ED). Interviews focused on the interval between patient arrival to the ED and clinician notification of a new patient arrival. Results revealed three EDs that were paper-based, two paperless and five using a combination of paper and electronic record.

PMID: 17238545 [Pubmed - in process]

2: AMIA Annu Symp Proc. 2006;:344-8.

Technology for emergency care: cognitive and workflow considerations.

Horsky J, Gutnik L, Patel VL.

Columbia University, Vanderbilt Clinic, 5th Fl, New York, NY 10032, USA.

Hospitals transitioning from paper to electronic information systems often find inadequate fit between newly implemented technology and work environment causing delays, inefficient use of resources and new kind of errors attributable to problems in human interaction with computer systems. The purpose of this study is to characterize the workflow, decision making and cognitive processing of clinicians in the process of care in emergency department of a large urban hospital and to suggest possible technological interventions for identified problem areas. Through the analysis of collected data we identified fifteen tasks and areas that either slowed work progress by unnecessary duplication or created potential for error generation. Recommendations are made for the replacement of currently inadequate or non-existent technology support of clinicians by information and communication technology specifically selected to fit the cognitive and workflow demands of the task.

PMID: 17238360 [Pubmed - in process]

3: J Healthc Inf Manag. 2006 Spring;20(2):45-54.

Effects of implementing computerized practitioner order entry and nursing documentation on nursing workflow in an emergency department.

Banet GA, Jeffe DB, Williams JA, Asaro PV.

Division of Emergency Medicine, Washington University School of Medicine, USA.

Nurses'perceptions of effective use of their time are critical to the successful implementation of information system changes. We examined the effects of implementing computerized practitioner order entry and nursing documentation in our emergency department with an anonymous survey of nurses and repeated time-motion studies. Emergency care nurses were positive about effects of CPOE, reporting needing less time to complete medication, laboratory, and radiology orders and less time spent clarifying orders. Their perceptions of time spent were congruent with observations from time-motion studies where combined computer-and-paper time and direct-patient-care time did not change significantly. Nurses also reported supplementing template options with free text, and those who were more comfortable using computers reported supplementing template options more often than their counterparts, suggesting that assessments of users' expertise in computer use may influence their ability to maximize their use of the functionality of emergency department information systems.

PMID: 16669588 [Pubmed - indexed for MEDLINE]

4: J Healthc Manag. 2005 Sep-Oct;50(5):327-40; discussion 341-2.

Emergency department overcrowding: the impact of resource scarcity on physician job satisfaction.

Rondeau KV, Francescutti LH.

Department of Public Health Sciences, University of Alberta, Canada. kent.rondeau@ualberta.ca

Emergency departments in most developed countries have been experiencing significant overcrowding under a regime of severe resource constraints. Physicians in emergency departments increasingly find themselves toiling in workplaces that are characterized by diminished availability of, limited access to, and decreased stability of critical resources. Severe resource constraints have the potential to greatly weaken the overall job satisfaction of emergency physicians. This article examines the impact of hospital resource constraints on the job satisfaction of a large sample of emergency physicians in Canada. After controlling for workflow and patient characteristics and for various institutional and physician characteristics, institutional resource constraints are found to be major contributors to emergency physician job dissatisfaction. Resource factors that have the greatest impact on job satisfaction include availability of emergency room physicians, access to hospital technology and emergency beds, and stability of financial (investment) resources.

PMID: 16268411 [Pubmed - indexed for MEDLINE]

5: Methods Inf Med. 2005;44(1):14-24.

Design and development of a mobile system for supporting emergency triage.

Michalowski W, Slowinski R, Wilk S, Farion KJ, Pike J, Rubin S.

School of Management, University of Ottawa, 136 Jean-Jacques Lussier St., Ottawa, Ontario K1N 6N5, Canada. wojtek@management.uottawa.ca

OBJECTIVES: Our objective was to design and develop a mobile clinical decision support system for emergency triage of different acute pain presentations. The system should interact with existing hospital information systems, run on mobile computing devices (handheld computers) and be suitable for operation in weak-connectivity conditions (with unstable connections between mobile clients and a server). METHODS: The MET (Mobile Emergency Triage) system was designed following an extended client-server architecture. The client component, responsible for triage decision support, is built as a knowledge-based system, with domain ontology separated from generic problem solving methods and used for the automatic creation of a user interface. RESULTS: The MET system is well suited for operation in the Emergency Department of a hospital. The system's external interactions are managed by the server, while the MET clients, running on handheld computers are used by clinicians for collecting clinical data and supporting triage at the bedside. The functionality of the MET client is distributed into specialized modules, responsible for triaging specific types of acute pain presentations. The modules are stored on the server, and on request they can be transferred and executed on the mobile clients. The modular design provides for easy extension of the system's functionality. A clinical trial of the MET system validated the appropriateness of the system's design, and proved the usefulness and acceptance of the system in clinical practice. CONCLUSIONS: The MET system captures the necessary hospital data, allows for entry of patient information, and provides triage support. By operating on handheld computers, it fits into the regular emergency department workflow without introducing any hindrances or disruptions. It supports triage anytime and anywhere, directly at the point of care, and also can be used as an electronic patient chart, facilitating structured data collection.

Publication Types:

   Research Support, Non-U.S. Gov't 

PMID: 15778790 [Pubmed - indexed for MEDLINE]

6: Acad Emerg Med. 2004 Nov;11(11):1135-41.

Computerized physician order entry and online decision support.

Handler JA, Feied CF, Coonan K, Vozenilek J, Gillam M, Peacock PR, Sinert R, Smith MS.

Department of Emergency Medicine, Northwestern University School of Medicine, Chicago, IL 60611, USA. jah505@northwestern.edu

Computerized physician order entry (CPOE) and decision support systems (DSS) can reduce certain types of error but often slow clinicians and may increase other types of error. The net effect of these systems on an emergency department (ED) is unknown. The consensus participants combined published evidence with expert opinion to outline recommendations for success. These include seamless integration of CPOE and DSS into systems and workflow; ensuring access to Internet-based and other online support material in the clinical arena; designing systems specifically for the ED and measuring their impact to ensure an overall benefit; ensuring that CPOE systems provide error and interaction checking and facilitate weight- and physiology-based dosing; using interruptive alerts only for the highest-severity events; providing a simple, vendor-independent interface for institutional customization of CPOE alert thresholds; maximizing the use of automated systems and passive data capture; and ensuring the widespread availability of CPOE and DSS using secure wireless and portable technologies where appropriate. Decisions regarding CPOE and DSS in the ED should be guided by the ED chair or designee. Much of what is believed to be true regarding CPOE and DSS has not been adequately studied. Additional CPOE and DSS research is needed quickly, and this research should receive funding priority. DSS and CPOE hold great promise to improve patient care, but not all systems are equal. Evidence must guide these efforts, and the measured outcomes must consider the many factors of quality care.

Publication Types:

   Comparative Study 
   Consensus Development Conference
   Review

PMID: 15528576 [Pubmed - indexed for MEDLINE]

7: Stud Health Technol Inform. 2002;90:707-11.

A web-based workflow system for emergency healthcare.

Poulymenopoulou M, Vassilacopoulos G.

Department of Informatics, University of Piraeus, Piraeus 18534, Greece.

Emergency healthcare delivery involves a variety of activities performed from the time of a call to the ambulance service till the time of patient's disposal from the emergency department of a hospital. Workflow systems have recently received considerable attention in the healthcare field since they overcome organizational structures and support collaboration and coordination requirements by automatically routing relevant information where and when needed. In particular, healthcare workflow systems implemented over the Web can form the basis for a collaborative environment by bringing together healthcare professionals who are geographically dispersed and, hence, creating virtual healthcare workgroups organized around patient care. In this paper, a web-based workflow system is presented that was developed to support emergency healthcare processes and to provide an infrastructure for the integration of pre-hospital and in-hospital emergency healthcare.

PMID: 15460784 [Pubmed - indexed for MEDLINE]

8: J Med Syst. 2003 Aug;27(4):325-35.

Specifying workflow process requirements for an emergency medical service.

Poulymenopoulou M, Malamateniou F, Vassilacopoulos G.

Department of Informatics, University of Piraeus, 80, Karaoli Dimitriou STR, Piraeus 185 34, Greece.

Recent trends in healthcare delivery have led to a gradual shift in the conceptualisation of healthcare information systems towards supporting healthcare processes in a more direct way. The move towards integrated and managed care, which requires designing healthcare processes around patient needs and incorporating efficiency considerations has led to an increased interest in process-oriented healthcare information systems based on workflow technology. This means to actively deliver the tasks to be performed to the right persons at the right time with the necessary information and the application functions needed. Moreover, workflow technology promotes a component-oriented development whereby the process logic is separated from application logic. This paper presents an approach to capturing process logic requirements for healthcare workflow systems with a view to design a system that is easily adjustable to process changes and to evolving organizational structures at a reasonable cost.

PMID: 12846464 [Pubmed - indexed for MEDLINE]

9: J Digit Imaging. 2001 Jun;14(2 Suppl 1):199-201.

Impact of a diagnostic workstation on workflow in the emergency department at a level I trauma center.

Hirschorn DS, Hinrichs CR, Gor DM, Shah K, Visvikis G.

Department of Radiology, New Jersey Medical School/University of Medicine and Dentistry of New Jersey, Newark 07103, USA. hirschor@undnj.edu

PURPOSE: When a computed tomography (CT) scan on a patient from the emergency department is completed at University of Medicine and Dentistry of New Jersey (UMDNJ)-University Hospital, a non-picture archiving and communication system (PACS) environment, formal diagnostic review cannot begin until the images are printed and transported to the on-call radiology resident. The time to reach a final diagnosis has been significantly reduced by the introduction of a single workstation in the on-call reading room. MATERIALS AND METHODS: Five radiology residents were studied. Each read 10 CT studies on film and 10 on a workstation. After a training period to familiarize the residents with the workstation, measurements were taken of the time required to read the examination and the time required for printing and transporting or networking the images. RESULTS: The average time required to transmit the images was reduced from approximately 40 minutes to 16 minutes. Interpretation times between the workstation and film were comparable. CONCLUSION: The addition of a single workstation significantly reduces the time required to reach a final diagnosis by obviating the need to print and transport the images to the on-call radiology resident. Such time savings can have a significant impact on the care of trauma patients.

PMID: 11442096 [Pubmed - indexed for MEDLINE]