It wasn’t long ago when staff at one of the busiest emergency departments (ED) in New York City got bogged down sifting through patient charts, deciphering physician notes and waiting for lab results as they cared for the more than 500 patients they often see in one day.
But thanks to an innovative technology solution and about a dozen LCD TV monitors, Lincoln Medical and Mental Health Center ED doctors and nurses can now spend more time on patient care and less on chart management.
New “Electronic White Boards” located in strategic locations within the ED now display time of arrival, how long a patient has been waiting, what exam room the patient is in, which physician or nurse has been assigned to that patient, and what medications, laboratory or radiology orders are pending. The system also displays the severity of the patient’s condition and sends visual cues with colored lights to indicate when the desired time to treatment is approaching and expected. The new electronic white boards will replace old manual white boards in all 11 HHC hospital emergency departments by the end of the summer.
“The electronic white boards help us to visually manage patient flow, improve communication among providers, help prevent errors, and ultimately improve the patient experience,” said Dr. Fernando Jara, Director of Emergency Medicine at Lincoln Medical Center. “Doctors, nurses and clerical staff can now track the status of patients in real-time at every step of the care process. It makes everyone in the ED accountable for the care that our patients receive from the time they walk in to the moment they leave.”
If the white boards show a provider column highlighted in red it means that the patient has been waiting longer than the desired time for the assigned emergency severity index number (ESI). A patient who comes in presenting with a heart attack would get an ESI of 1 which requires immediate attention, a patient with an ESI of 2 would need to be seen within 15 to 30 minutes, and a patient with a minor injury would get an ESI of 4 or 5 and typically be seen in the ED Urgent Care Area for expedited care.
According to Dr. Jara, no one on the staff wants to see a red cell on the tracking board, but when they do turn red, it triggers a nurse’s intervention, a second assessment of the patient’s condition, and notification of the ER physician to initiate treatment.
“Managing and sharing patient information that is timely and accurate is absolutely critical to running an efficient emergency department,” said Dr. Mary Ryan, Attending Physician at Lincoln Medical Center. “Being able to locate and track the patients under my care at a glance is extremely time efficient.”
The electronic system that populates the white boards consists of clinical documentation templates that capture key information for each stage of the patient flow: arrival, triage, assessment, disposition, and wait time for hospital admission. Once patient information is collected and documented in the system, the data then flows through the existing electronic medical records (EMR) system and is displayed on the monitors throughout the EDs.
Preliminary data for most hospitals using the new electronic system show that patient length of stay from triage to discharge has decreased. At Lincoln Hospital, the median time between triage and discharge was reduced by nearly 25 minutes between January and May of this year. More official data is still being compiled.
“I believe this new technology is going to make a difference in our patient’s satisfaction.” said Isatou Tambadou, Clerical Associate in the Lincoln ED. “When we used manual white boards, physicians had to wait to get paper charts before they saw the patients. Now they can see which patients are waiting to be seen and can quickly move from patient to patient without interruption and without waiting on someone else to give them the information they need to conduct the examination.”
As an extra bonus, the electronic documentation and white board system, which was developed by the HHC IT team in the Spring of 2010 to help address the challenges in managing more than 1 million ED visits a year, also helps capture standard quality and clinical measurements that will be required to achieve IT “Meaningful Use” designation by the federal government. Because the white boards are integrated with the EMR system, doctors and nurses can now record vital patient information through their documentation in the EMR and have visual real time updates on the white boards.
“Running an efficient ED positively affects the quality of care that we give our patients,” added Dr. Jara. “During my time here, there has not been another single thing that has helped to re-energize the ED staff and improve productivity as much as the electronic white boards.”