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Electronic Tracking Does Everything Except Wash Windows

2003; Lippincott Williams & Wilkins; Volume: 25; Issue: 10 Linguagem: Inglês

10.1097/00132981-200310000-00016

1552-3624

Anne Scheck,

What a difference a data screen makes. Though most of the staff in Good Samaritan Hospital emergency department in Vincennes, IN, wouldn't call it that, that's what it is: a computer screen full of patient chronologies, accumulated in real time, during an ED visit — an electronic white board. But to Thomas J. Dagney, DO, an emergency physician there, the new system also has database potential written all over it. Dr. Dagney, the medical director of the hospital, said the new patient-tracking system, which looks like an ordinary computer, is making a significant difference in patient satisfaction. It is making such a difference, in fact, that patient surveys are reflecting statistically significant improvements. Why? It can pinpoint inappropriate patient delays and keep staff workflow smooth and steady.Figure: Staff at Good Samaritan Hospital using the ED's new tracking software.The system, the Horizon Emergency Care Tracking Board (McKesson's, San Francisco, CA), electronically follows a patient from reception to admission. The electronic board assists in triage, interfaces with the lab, reports the status of tests, and keeps tabs on the time involved in patient care. “What a difference it makes for us in patient care,” Dr. Dagney said. “It is very easy to get a rapid scan of all the ED patients, and [find out] who is in the waiting room.” Only a few short years ago, a patient visiting Good Samaritan's emergency department told a different story: Wait times of up to six hours were not unusual. Now, however, emergency personnel can tell at a glance and by a few keystrokes whether a patient has been waiting for an hour or more (a yellow light pops up with the name). Department Coordination For patients who already have been ushered into an ED room, the system identifies those being treated and even indicates which staff members are caring for them. In fact, the information is so readily available that coordination between the main ED and the fast-track one next door has increased to the point that Dr. Dagney said he often hops back and forth between the two during his shift, depending on where there is a lapse of delivery or a lull in need. The system also avoids problems he used to encounter: The man with chest pain who wasn't given proper triage; the boy with a bellyache and fever who didn't have the flu but full-blown appendicitis. The electronic board allows physicians to review the patients awaiting examination, allowing him to detect those with more serious complaints. “I like the security of what is going on around me,” Dr. Dagney said. Though built for desktop computers, wireless laptops are used in some patient areas. On ones in which screens might be visible to other patients or visitors, the patient's initials are the only identification used. In addition, the screen vanishes when it is not in use. Carol Olson, the vice president of nursing for Good Samaritan, said it wasn't that difficult to change from the old white board to the new electronic version. By now, nearly everyone is used to using computers, and it was easy to get the hang of things, she said. Of course, when the system crashes, the opposite is true; ED staff has a tough time back-pedaling to manual tracking. The system has yielded such improvements on patient satisfaction scores in key areas such as “doctor's concern for comfort” and “nurse's attention to patient” that it generated calls from other hospitals and at least one site visit from another facility, Ms. Olson said.FigureOrganizing Data And the system has proven so work-enhancing that it was the subject of an article documenting the gains (J Emerg Nurs 2003;29[1]:39) In the article, Good Samaritan nurse Elisa Boger, RN, noted that “factors driving the need for change were the inability to organize key patient data and make it accessible to all ED staff.” Moreover, there were gaps in care from “lost data and chaotic work flow, and the inability to provide management with key information for decision-making and continuous quality improvement processes in an automated, timely manner,” she noted.Figure: The ED staff uses the system to track patients from triage to discharge.Although it isn't known precisely how many hospitals have switched to an electronic tracking system, penetration of this new technology is thought to be highest in centers depending on local reputation to keep patient demand high, such as suburban hospitals. Surveys of medical facilities and their use of “paperless reporting” show that a majority haven't yet converted to systems of electronic computer technology for that purpose (J Qual Improvement 2002;28[7]:387). Dr. Dagney said he foresees a day when the electronic white board interfaces with all departments that support emergency medicine. Eventually, he predicted, the system will become something like a database, showing discharge diagnoses and recording the time involved in all aspects of care. Even before that day arrives, the new system has proven it is “good for overall organization,” he said.