Emergency Room Of The Future Leveraging IT At WellStar Health System: Kennestone Emergency Department - PowerPoint PPT Presentation

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Emergency Room Of The Future Leveraging IT At WellStar Health System: Kennestone Emergency Department

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  1. Emergency Room Of The FutureLeveraging IT At WellStar Health System:Kennestone Emergency Department September 18, 2008 Jon Morris, MD, FACEP, MBA WellStar Health Systems

  2. Agenda • Introduction • Kennestone Emergency Department • Metrics • More Metrics- Exit Phase • Even More Metrics- Non-ED Physicians • So far…

  3. 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

  4. Example: 2007 Adverse Drug Events

  5. 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

  6. Kennestone ED

  7. Kennestone Emergency Department >102,000 Annual patient volume 40% of Kennestone admissions 24.38% admit rate (July 08) October 2007: ED Online

  8. ED Flow “Before”

  9. Paper ED Record

  10. Completed ED Evaluation - Waiting For MD

  11. 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)

  12. ED Flow “After”

  13. ED Tracking Board WSKH ED Applications

  14. Patients Waiting For MD

  15. ED Patients: Status & Tasks

  16. Documentation WSKH ED Applications

  17. Online Documentation • Always Available • Real-time • Legible • Automated Date & Time • All Clinical Documentation In One Place • More Complete

  18. ED MD Charting

  19. Paper vs. HEC- MD Note

  20. Order Entry WSKH ED Applications

  21. Definition: CPOE • Provider Enters Orders • Clinical Decision Support • Easier to do the right thing • Harder to do the wrong thing • Immediate Order Transmission

  22. Tools: I-Forms

  23. Tools: Order Outlines

  24. “Easier To Do The Right Thing:” Weight-based Dosing

  25. “Easier To Do The Right Thing:” Weight-based Dosing

  26. Leveraging CPOE: Automation

  27. “Harder To Do The Wrong Thing”

  28. Allergy Checking

  29. Allergy Alert

  30. 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

  31. 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

  32. The Competition

  33. 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

  34. Implementation WSKH ED

  35. Challenges in Implementing HEC-HEO • Development • Training • Deployment • Adoption • Reporting

  36. Implementing HEC-HEO

  37. The Good-

  38. The Bad-

  39. And the Ugly Truth.

  40. One solution… “In the middle of every difficulty lies opportunity” - Albert Einstein

  41. A Better Way: Metrics

  42. 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.

  43. 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

  44. ED Metrics

  45. The Good: Reliable ED Metrics ERK - July 2008

  46. 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

  47. 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)