Gibson, Michael Joseph, (3 June 1876–13 Sept. 1953), Consulting Gynæcologist to the Richmond Hospital, Dublin; Consulting Surgeon to the Coombe Hospital, Dublin

Gordon Morgan Holmes was born in Dublin on 22 February 1876, the son of Gordon Holmes and his wife Kathleen Morgan). There were three brothers and a sister all of whom survive. The family is believed to have come to Ireland from Yorkshire and to have been settled in King’s County during the last of the Cromwellian plantations at the time of the Acts of Settlement in 1652. Holmes’s mother acquired by inheritance Dellin House and property at Castle Bellingham, Co. Louth, just south of the Ulster border, and this then became the family home and was farmed by his father. In complexion, physique and predominantly in temperament, Holmes was indubitably an Irishman, and during the centuries Irish blood must have mingled with the English strain. His mother died while he was a child and his formal education began late. He has said that he taught himself to read, but it is recalled that later in the village school his schoolmaster discerning unusual ability in the lad voluntarily gave him extra tuition. Thence he went as a boarder to the Dundalk Educational Institute where his schooling was completed. The school had a reputation for turning out good mathematicians, and when Holmes went up to Trinity College, Dublin, his choice wavered between reading mathematics or classics. But he was a determined walker, and had rapidly grown to love the Wicklow Hills, so easily within reach of Dublin, and to develop an interest in their flora. He thus decided to read natural science, was attracted by botany and biology, and so became a medical student. In 1897 he took his B.A., Senior Moderator in Natural Science, graduated in medicine in 1897 and proceeded M.D. in 1903. During his course he took a number of scholarships and a travelling prize. His hospitals were the Sir Patrick Dunn’s and—after graduation—the Richmond Hospital.

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MP03: Strategies to minimize impact of electronic health record implementation on emergency department flow

CJEM ◽

10.1017/cem.2019.138 ◽

2019 ◽

Vol 21 (S1) ◽

pp. S42-S43

Author(s):

E. Grafstein ◽

S. Horak ◽

J. Kung ◽

J. Bonilla ◽

R. Stenstrom

Keyword(s):

Electronic Health Record ◽

Productivity Loss ◽

Admission Rate ◽

Richmond Hospital ◽

Health Record ◽

Chi Square ◽

Control Hospital ◽

Time Periods ◽

Electronic Health ◽

The Impact

Introduction: Electronic health record (EHR) implementation can be associated with a slowdown in performance and delayed return to pre go-live productivity. The objective of this study is to describe the impact of a go-live strategy including diversion, public advertising of the go-live, and extra physician staffing to mitigate productivity loss. Methods: Lions Gate Hospital (LGH), an urban community hospital and rural referral centre with 250 beds and 65,000 annual ED visits went live with Cerner HER (Cerner Corporation, Kansas, MO) on April 28, 2018. The implementation included complete electronic ordering and electronic physician documentation. We compared patients seen per hour, time to physician (TTMD), ED length of stay (EDLOS), patients per hour left without being seen (LWBS), and admission rate (AR) for the 6 weeks prior to implementation (Pre), 2 weeks during (Imp), and 6 weeks after (Post) for LGH and a control hospital (Richmond Hospital – comparable in size/acuity) for the same periods. Medians were compared using the Mann-Whitney test for patients/hour, EDLOS and TTMD, and chi-square for AR and LWBS. Results: Patients/hour seen went from 2.1/hour in the pre phase, but dropped to 1.7/hr in the 2 week period following implementation (P < 0.05). During weeks 2-8 post implementation, 2,3 patients per hour were seen (P = 0.38 compared to Pre phase). At the control hospital, patients per hour were comparable across all time periods (Ps > 0.3). Median time to physician was 54, 56, and 54 minutes at LGH for the Pre, Imp, and Post time periods (Ps > 0.3). Median EDLOS was 184, 196, and 184 minutes in the pre, Imp, and post phases (P Imp versus pre = 0.11; Pre versus post = 0.54). LWBS rate was 1.3%, 2.9, and 2.4% (Ps for Imp and Post versus pre <0.05) at LGH, but the pattern was similar for the control hospital (2.9%, 4.1% and 4.0%’ Ps <0.05). There was no significant change in ambulance arrivals or admission rate at either hospital (Ps > 0.2). Conclusion: A deliberate implementation strategy that focuses on ED physician upstaffing and visit diversion can smooth the impact of the implementation of an EHR so that patient care is not impacted significantly. Return to normal productivity occurred by 8 weeks post go-live. We demonstrate a strategy that may support easier implementation at other sites.

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