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Emergency Room Of The Future Leveraging IT At WellStar Health System: Kennestone Emergency Department. September 18, 2008. Jon Morris, MD, FACEP, MBA WellStar Health Systems. Agenda. Introduction Kennestone Emergency Department Metrics More Metrics- Exit Phase
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Emergency Room Of The FutureLeveraging IT At WellStar Health System:Kennestone Emergency Department September 18, 2008 Jon Morris, MD, FACEP, MBA WellStar Health Systems
Agenda • Introduction • Kennestone Emergency Department • Metrics • More Metrics- Exit Phase • Even More Metrics- Non-ED Physicians • So far…
To Err Is Human • Patient Safety Issues: IOM report Nov. 1999 • > 44,000 – 96,000 deaths related to preventable medical errors/year • $17B - $29B cost • 2000 – Leapfrog Group
The Need For Change “The definition of insanity is to continue to do the same thing over and over again and expect different results” Albert Einstein
Kennestone Emergency Department >102,000 Annual patient volume 40% of Kennestone admissions 24.38% admit rate (July 08) October 2007: ED Online
October 2007: Kennestone ED Live Online Documentation and Order Entry • “Sole Source” strategy- McKesson • 18 month build • ED Tracking Board • Online Clinical Documentation (Horizon Emergency Care – HEC) • Online Order Entry (Horizon Expert Orders - HEO)
ED Tracking Board WSKH ED Applications
Documentation WSKH ED Applications
Online Documentation • Always Available • Real-time • Legible • Automated Date & Time • All Clinical Documentation In One Place • More Complete
Order Entry WSKH ED Applications
Definition: CPOE • Provider Enters Orders • Clinical Decision Support • Easier to do the right thing • Harder to do the wrong thing • Immediate Order Transmission
CPOE: A Process • Multiple applications • Provider • Nursing • Pharmacy • Ancillary Services, i.e., Laboratory, Medical Imaging • Global process - multiple stakeholders • KLAS: 17.5% US Hospitals > 200 beds in 2007
CPOE- Financial Gains CPOE in Community Hospitals: • ADE cost • Renal dosing errors • Unnecessary / Redundant diagnostic studies • IV to PO conversion • $2.7M Reduction in Cost, 26 month payback* * Feb 08 MA CPOE Initiative Report
Goals- WellStar Health System • Improve Care • Lower Costs • CPOE Using HEO • Two Years To First Facility Go-live • 100% Physician Adoption Two Years Post-live
Implementation WSKH ED
Challenges in Implementing HEC-HEO • Development • Training • Deployment • Adoption • Reporting
One solution… “In the middle of every difficulty lies opportunity” - Albert Einstein
Throughput Analysis • Neglected value of ED applications • Acquire data from HEC & TB. • Quarantine invalid data • Report data compliance, i.e., reporting efficacy and accuracy. • Select and study throughput intervals. • Identify high-yield opportunities.
WS KH ED - Throughput Intervals • Arrival to Triage • Arrival to Bed • Arrival to EDMD Assigned • Arrival to EDMD At Bedside • Bed to EDMD at Bedside • EDMD at Bedside to EDMD Decision to Disposition • EDMD Decision to Disposition to RN Disposition • RN Disposition to Exit • LOS
The Good: Reliable ED Metrics ERK - July 2008
The Bad: Delays in Seeing EDMD Admitted Patients: Patient Arrival to MD At Bedside: 61 minutes Patient in Bed to MD At Bedside: 42 minutes
The Ugly: Delays in Exit From ED July 2008 EDMD Decision to Admit to Exit from ED: Exit Phase = EDMD Decision to Admit → Patient Exit From ED 162 + 10 = 172 minutes 39-47% Average ED Patient LOS (Jan – July 2008)