Baylor University Medical Center Proceedings April 2017 - 148

the three covariates. The time metrics
were grouped into pre- and postimplementation. Means and standard
errors of the two major groups for
each dependent variable were obtained for the 12 months before and
the 12 months after EHR implementation. P values were obtained
by comparing pre vs. post and adjusting for number of admits, transfers,
and month. Any P value <0.05 was
considered statistically significant.

Figure. Monthly census means.

orders continued on paper until May 7, 2013, when CPOE
was implemented. A simultaneous project was implemented
on March 3, 2013, as a bedding initiative in an effort to reduce
the door-to-admission time for newly admitted patients. Resident physicians utilized paper documentation with hand-off
to supervising attending physicians. Board-certified emergency
medicine attending physicians utilized dictation for formal,
electronic patient encounter documentation.
ED metrics were analyzed during the timeframe of March
1, 2012, to February 28, 2014, with the break in pre- and postimplementation occurring on March 1, 2013. This information
was compiled on a data information sheet for each 24-hour
day. Individual data points were collected through standardized reporting from the ED operations committee. The ED
metrics were collected for each day and grouped as dependent
variables; they included LOS for admitted patients and nonadmitted patients, door-to-door time for discharged patients,
door-to-admission time, door-to-bed time, bed-to-provider
time, provider-to-disposition time, and disposition-to-admit
time. In addition to the service time metrics above, the data
for total ED visits, admission rates, and transfer rates were collected. Outcome measures for patient flow that may correlate
with prolonged ED service times were also measured and included leaving against medical advice and leaving without being
seen. Each of these grouped dependent variables was used in
analysis of variance and compared to the ED metric timeframes
before and after EHR implementation for each metric. The
three covariates used to adjust for month-to-month variation
and patient acuity differences within the groups were month,
admission rate, and transfer rate.
Excel was used to calculate time metrics. Considering that
the data set contained errors, patient data were only excluded
if the data resulted in the integer of "0." When standard errors
and means were calculated with and without these data points,
there was no significant difference. To determine standard error
between the two groups, the dependent variable time stamps were
determined for each patient encounter. These were averaged each
day, then for the month, and then adjusted as above for each of
148

RESULTS
A total of 100,198 ED visits
were reviewed and included in this
analysis, including 701,323 unique
ED metric data points. Of these
metric data points, 378,560, or 54%, were from after EHR
implementation. During the course of the study, 13,174 patients were admitted, with the remaining number of patients
either being discharged from the ED, transferred to another
facility, leaving against medical advice, or leaving without being seen. The average monthly volume did not significantly
change after implementation (P = 0.11) (Figure). Similarly, the
monthly admission and transfer rates were also not significantly
different from pre- to postimplementation, each with a P value
of 0.06 (Table).
The mean LOS increased from 92.4 to 95.4 minutes (P =
0.01), with a change that persisted for more than 12 months
after implementation. This trend persisted through many of
the service intervals. The mean door-to-door time for total
throughput time of ambulatory patients remained prolonged by
increasing from 76.8 minutes to 81.6 minutes (P = 0.01). The
mean door-to-bed time showed a statistically significant increase
Table. Metrics before and after implementation of an electronic
health record in an emergency department
Mean (standard error)
Measure

Pre-EHR

Mean
P
Post-EHR difference value

Monthly volume (n)

4023 (84) 3863 (75)

160

0.11

Monthly admissions (n)

528 (17.1) 489 (13.6)

39

0.06

Monthly transfer (n)

4

0.06

Length of stay (min)

92.4 (1.6) 95.4 (1.0)

17 (1.3)

13 (0.7)

3.0

0.01

Door-to-door time (min)

76.8 (1.2) 81.6 (0.6)

4.8

0.01

Door-to-admission time (min)

192 (4.0) 193.8 (0.2)

1.8

0.11

Door-to-bed time (min)

10.8 (0.5) 13.8 (0.5)

3.0

0.01

Bed-to-provider time (min)

4.2 (0.1)

3.0 (0.1)

-1.2

<0.01

Provider-to-disposition time (min) 48.0 (0.7) 49.8 (0.4)

1.8

0.01

85.8 (2.7) 78.6 (3.1)

-7.2

0.80

Leaving against medical advice (n) 6.3 (0.85) 11.6 (1.17)

5.3

<0.01

Leaving without being seen (n) 19.5 (4.33) 15.5 (2.23)
 

4.0

0.24

Disposition-to-admit time (min)

Baylor University Medical Center Proceedings

Volume 30, Number 2



Table of Contents for the Digital Edition of Baylor University Medical Center Proceedings April 2017

No label
Baylor University Medical Center Proceedings April 2017 - No label
Baylor University Medical Center Proceedings April 2017 - Cover2
Baylor University Medical Center Proceedings April 2017 - 137
Baylor University Medical Center Proceedings April 2017 - 138
Baylor University Medical Center Proceedings April 2017 - 139
Baylor University Medical Center Proceedings April 2017 - 140
Baylor University Medical Center Proceedings April 2017 - 141
Baylor University Medical Center Proceedings April 2017 - 142
Baylor University Medical Center Proceedings April 2017 - 143
Baylor University Medical Center Proceedings April 2017 - 144
Baylor University Medical Center Proceedings April 2017 - 145
Baylor University Medical Center Proceedings April 2017 - 146
Baylor University Medical Center Proceedings April 2017 - 147
Baylor University Medical Center Proceedings April 2017 - 148
Baylor University Medical Center Proceedings April 2017 - 149
Baylor University Medical Center Proceedings April 2017 - 150
Baylor University Medical Center Proceedings April 2017 - 151
Baylor University Medical Center Proceedings April 2017 - 152
Baylor University Medical Center Proceedings April 2017 - 153
Baylor University Medical Center Proceedings April 2017 - 154
Baylor University Medical Center Proceedings April 2017 - 155
Baylor University Medical Center Proceedings April 2017 - 156
Baylor University Medical Center Proceedings April 2017 - 157
Baylor University Medical Center Proceedings April 2017 - 158
Baylor University Medical Center Proceedings April 2017 - 159
Baylor University Medical Center Proceedings April 2017 - 160
Baylor University Medical Center Proceedings April 2017 - 161
Baylor University Medical Center Proceedings April 2017 - 162
Baylor University Medical Center Proceedings April 2017 - 163
Baylor University Medical Center Proceedings April 2017 - 164
Baylor University Medical Center Proceedings April 2017 - 165
Baylor University Medical Center Proceedings April 2017 - 166
Baylor University Medical Center Proceedings April 2017 - 167
Baylor University Medical Center Proceedings April 2017 - 168
Baylor University Medical Center Proceedings April 2017 - 169
Baylor University Medical Center Proceedings April 2017 - 170
Baylor University Medical Center Proceedings April 2017 - 171
Baylor University Medical Center Proceedings April 2017 - 172
Baylor University Medical Center Proceedings April 2017 - 173
Baylor University Medical Center Proceedings April 2017 - 174
Baylor University Medical Center Proceedings April 2017 - 175
Baylor University Medical Center Proceedings April 2017 - 176
Baylor University Medical Center Proceedings April 2017 - 177
Baylor University Medical Center Proceedings April 2017 - 178
Baylor University Medical Center Proceedings April 2017 - 179
Baylor University Medical Center Proceedings April 2017 - 180
Baylor University Medical Center Proceedings April 2017 - 181
Baylor University Medical Center Proceedings April 2017 - 182
Baylor University Medical Center Proceedings April 2017 - 183
Baylor University Medical Center Proceedings April 2017 - 184
Baylor University Medical Center Proceedings April 2017 - 185
Baylor University Medical Center Proceedings April 2017 - 186
Baylor University Medical Center Proceedings April 2017 - 187
Baylor University Medical Center Proceedings April 2017 - 188
Baylor University Medical Center Proceedings April 2017 - 189
Baylor University Medical Center Proceedings April 2017 - 190
Baylor University Medical Center Proceedings April 2017 - 191
Baylor University Medical Center Proceedings April 2017 - 192
Baylor University Medical Center Proceedings April 2017 - 193
Baylor University Medical Center Proceedings April 2017 - 194
Baylor University Medical Center Proceedings April 2017 - 195
Baylor University Medical Center Proceedings April 2017 - 196
Baylor University Medical Center Proceedings April 2017 - 197
Baylor University Medical Center Proceedings April 2017 - 198
Baylor University Medical Center Proceedings April 2017 - 199
Baylor University Medical Center Proceedings April 2017 - 200
Baylor University Medical Center Proceedings April 2017 - 201
Baylor University Medical Center Proceedings April 2017 - 202
Baylor University Medical Center Proceedings April 2017 - 203
Baylor University Medical Center Proceedings April 2017 - 204
Baylor University Medical Center Proceedings April 2017 - 205
Baylor University Medical Center Proceedings April 2017 - 206
Baylor University Medical Center Proceedings April 2017 - 207
Baylor University Medical Center Proceedings April 2017 - 208
Baylor University Medical Center Proceedings April 2017 - 209
Baylor University Medical Center Proceedings April 2017 - 210
Baylor University Medical Center Proceedings April 2017 - 211
Baylor University Medical Center Proceedings April 2017 - 212
Baylor University Medical Center Proceedings April 2017 - 213
Baylor University Medical Center Proceedings April 2017 - 214
Baylor University Medical Center Proceedings April 2017 - 215
Baylor University Medical Center Proceedings April 2017 - 216
Baylor University Medical Center Proceedings April 2017 - 217
Baylor University Medical Center Proceedings April 2017 - 218
Baylor University Medical Center Proceedings April 2017 - 219
Baylor University Medical Center Proceedings April 2017 - 220
Baylor University Medical Center Proceedings April 2017 - 221
Baylor University Medical Center Proceedings April 2017 - 222
Baylor University Medical Center Proceedings April 2017 - 223
Baylor University Medical Center Proceedings April 2017 - 224
Baylor University Medical Center Proceedings April 2017 - 225
Baylor University Medical Center Proceedings April 2017 - 226
Baylor University Medical Center Proceedings April 2017 - 227
Baylor University Medical Center Proceedings April 2017 - 228
Baylor University Medical Center Proceedings April 2017 - 229
Baylor University Medical Center Proceedings April 2017 - 230
Baylor University Medical Center Proceedings April 2017 - 231
Baylor University Medical Center Proceedings April 2017 - 232
Baylor University Medical Center Proceedings April 2017 - 233
Baylor University Medical Center Proceedings April 2017 - 234
Baylor University Medical Center Proceedings April 2017 - 235
Baylor University Medical Center Proceedings April 2017 - 236
Baylor University Medical Center Proceedings April 2017 - 237
Baylor University Medical Center Proceedings April 2017 - 238
Baylor University Medical Center Proceedings April 2017 - 239
Baylor University Medical Center Proceedings April 2017 - 240
Baylor University Medical Center Proceedings April 2017 - 241
Baylor University Medical Center Proceedings April 2017 - 242
Baylor University Medical Center Proceedings April 2017 - 243
Baylor University Medical Center Proceedings April 2017 - 244
Baylor University Medical Center Proceedings April 2017 - 245
Baylor University Medical Center Proceedings April 2017 - 246
Baylor University Medical Center Proceedings April 2017 - 247
Baylor University Medical Center Proceedings April 2017 - 248
Baylor University Medical Center Proceedings April 2017 - 249
Baylor University Medical Center Proceedings April 2017 - 250
Baylor University Medical Center Proceedings April 2017 - 251
Baylor University Medical Center Proceedings April 2017 - 252
Baylor University Medical Center Proceedings April 2017 - Cover3
Baylor University Medical Center Proceedings April 2017 - Cover4
http://www.brightcopy.net/allen/bapr/30-4
http://www.brightcopy.net/allen/bapr/30-3
http://www.brightcopy.net/allen/bapr/30-2
http://www.brightcopy.net/allen/bapr/30-1
http://www.brightcopy.net/allen/bapr/29-4
http://www.brightcopy.net/allen/bapr/29-3
http://www.brightcopy.net/allen/bapr/29-2
http://www.brightcopy.net/allen/bapr/29-1
http://www.brightcopy.net/allen/bapr/28-04
https://www.nxtbook.com/allen/bapr/28-3
https://www.nxtbook.com/allen/bapr/28-2
https://www.nxtbook.com/allen/bapr/28-1
https://www.nxtbook.com/allen/bapr/27-4
https://www.nxtbook.com/allen/bapr/27-3
https://www.nxtbookmedia.com