IMPACT OF ELECTRONIC HEALTH

RECORD IMPLEMENTATION ON PATIENT

FLOW METRICS IN A PEDIATRIC
EMERGENCY DEPARTMENT

By:
Maab Khalil

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 Background

EHR has seen a tremendous increase in the

number of hospitals and healthcare centers
adopting EHR systems with the goal of
improving healthcare quality and efficiency
during periods high stress.

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 Background

I chose this research to evaluate the effect of EHR

implementation on:

• Overall patient LOS of Admission and Discharge

• Time to a medical provider

• The impact of offloading low acuity visits to an

alternative care site from the ED during EHR
implementation.

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 Primary Question

Does EHR implementation effect Pediatric ED

patient metric?

What impact of offloading Low acuity patients to

alternative sites during EHR Rollout do?

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 Methods

1. Study design: Analysis of variance

2. Cincinnati Children's Hospital Medical Center (CCHMC).

3. ED patients were observed in a 4 time events of 2 week

duration and 9 month after EHR implementation.

4. ED stressor is H1N1 virus surge.

5. Low acuity patients, do not show H1N1 signs.

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 Methods
Testing conditions:
• The mean sample size for all time events was 3281 (range 3154–3333)
• Monitor LOS of Admission and Discharge
• Monitor the Mean time to MD/Room
• Monitor the OC%- were low acuity patients who are directed to different area of ED
• Time line events
1. Before Rollout – OC was absent + Beginning of Surge
2. Before Rollout - OC was present + End of Surge
3. During Rollout - OC was present
4. After Rollout - OC was absent
5. 9 month later Post Rollout

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 Results

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 Discussion
• During the overflow clinic activation, and before EHR
implementation nearly 10% of patients were diverted to
the overflow clinic.

• The overflow clinic during H1N1 surge did appear to

reduce the overall LOS before the implementation

• 95% CI showed decreased LOS during the Time 1 and 2

– Admissions – 5: 28 min to 4:50 min

– Discharge – 2:59 to 2:45 min

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 Discussion
• However, during EHR implementation, the Overflow clinic did not have
any impact during EHR implementation.

• The overall LOS for both groups exceeded both the H1N1 pre-overflow
clinic Time 1 as well as the H1N1 overflow clinic Time 2.

• During EHR implementation, 95% CI showed increased LOS:

– Admissions – 5:36 min

– Discharge – 3:25 min

• Both LOS dropped back to pre-H1N1 average LOS after 3 months.

• Despite consistency during all blocks in Mean time to room, there was a
significant increase in Mean time to doctor in the first 2 weeks after EHR
implementation from 47 min to 70 min (p<0.001).
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 Limitations/Future Research: 1 slide

Limitations:
• As this was an observational study no causality can be correctly recognized from our data.
• No effort was made to manipulate the control groups because the research is simply observing the Quality Metric of
ED without influencing the outcome in any way.
• No major EHR operational changes or factors during this time. Training EHR staff on using EHR system or update to
EHR system
• EHR rollout was the largest contributing factor that affected LOS of admission and Discharge, and the Time to MD.

Future:
• Despite patient flow delays, staffing and limited diversion of low acuity patients. I found out that patient metrics
returned to baseline levels by 3 months.
• This is crucial and can help other hospital/ED groups recognize potential needs when planning an EHR
implementation.
• Further study is required to recognize possible defenses to ensure patient safety during such a period of operational
change.

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 References

Kennebeck, S. S., Timm, N., Farrell, M. K., and Spooner, S. A.,(2011). Impact of

electronic health record implementation on patient flow metrics in a pediatric

emergency department. J Am Med Inform Assocv.19(3); May-Jun 2012. Retreived

from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3341791/.

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