scholarly journals The impact of electronic medical record implementation on operating room efficiency

2015 ◽  
Vol 5 (1) ◽  
pp. 48 ◽  
Author(s):  
Richard Frazee ◽  
Alisa Cames ◽  
Yolanda Munoz Maldonado ◽  
Timothy Bittenbinder ◽  
Harry T Papaconstantinou
Keyword(s):  
Learning Curve ◽  
Medical Record ◽  
Operating Room ◽  
Electronic Medical Record ◽  
Control Charts ◽  
Analysis Data ◽  
Operating Room Efficiency ◽  
Start Time ◽  
Implementation Level ◽  
The Impact

Background: First start delays in the operating room have a downstream effect on operating room efficiency and patient satisfaction. In accordance with the American Recovery and Reinvestment Act, in February 2014, our institution adopted EPICTM as our electronic health record (EHR). The impact of the transition from paper to electronic documentation on operating room efficiency is not known. This study analyzed first start data as a measure of overall operative suite efficiency, looking at the initial impact and the learning curve to return to baseline parameters.Methods: A retrospective review of on time start data was reviewed for three months prior and 4 months after implementation of the EHR. A start was considered delayed if the patient arrived to the room after the 7:30 start time. Patients transported from the intensive care unit were excluded from analysis. Data was analyzed using control charts for the percentages and comparison of means using Dunnet’s methods. Confidence intervals were calculated at .05 and .01 for significance.Results: After EPIC implementation, there was an initial drop in on time starts from over 60% to 41% followed by gradual return to pre-implementation level within 4 months (p < .01).Conclusions: Implementation of an EHR produced decreased efficiency in on time first starts in the operative suite, but the learning curve was brief, returning to baseline values in 4 months. These findings can serve as a guide for other institutions that are undergoing transition from a paper to an electronic medical record.

Increasing Operating Room Efficiency through Electronic Medical Record Analysis

2016 ◽  
Vol 26 (5) ◽  
pp. 106-113 ◽  
Author(s):  
AF Attaallah ◽  
OM Elzamzamy ◽  
AL Phelps ◽  
P Ranganthan ◽  
MC Vallejo
Keyword(s):  
Medical Record ◽  
Operating Room ◽  
Electronic Medical Record ◽  
Operating Room Efficiency

scholarly journals Adult Learning Principles and Peer Delivery Improve Satisfaction of Electronic Medical Record Onboarding Education

ACI Open ◽  
2020 ◽  
Vol 04 (02) ◽  
pp. e114-e118
Author(s):  
Joanna Lawrence ◽  
Sharman Tan Tanny ◽  
Victoria Heaton ◽  
Lauren Andrew
Keyword(s):  
Adult Learning ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Junior Doctors ◽  
Free Text ◽  
Organizational Safety ◽  
Adult Learning Principles ◽  
Learning Practices ◽  
Learning Principles ◽  
The Impact

Abstract Objectives Given the importance of onboarding education in ensuring the safety and efficiency of medical users in the electronic medical record (EMR), we re-designed our EMR curriculum to incorporate adult learning principles, informed and delivered by peers. We aimed to evaluate the impact of these changes based on their satisfaction with the training. Methods A single site pre- and post-observational study measured satisfaction scores (four questions) from junior doctors attending EMR onboarding education in 2018 (pre-implementation) compared with 2019 (post-implementation). An additional four questions were asked in the post-implementation survey. All questions employed a Likert scale (1–5) with an opportunity for free-text. Raw data were used to calculate averages, standard deviations and the student t-test was used to compare the two cohorts where applicable. Results There were a total of 98 respondents in 2018 (pre-implementation) and 119 in 2019 (post-implementation). Satisfaction increased from 3.8/5 to 4.5/5 (p < 0.0001) following implementation of a peer-delivered curriculum in line with adult learning practices. The highest-rated factors were being taught by other doctors (4.9/5) and doctors having the appropriate knowledge to deliver training (4.9/5). Ninety-two percent of junior doctors were motivated to engage in further EMR education and 90% felt classroom support was adequate. Conclusion EMR onboarding education for medical users is a critical ingredient to organizational safety and efficiency. An improvement in satisfaction ratings by junior doctors was demonstrated after significant re-design of the curriculum was informed and delivered by peers, in line with adult learning principles.

scholarly journals REGIONAL TECHNOLOGICAL LEARNING IN TURKISH CEMENT INDUSTRY

2020 ◽  
Vol 8 (4) ◽  
pp. 204-216
Author(s):  
Gurkan Calmasur ◽  
◽  
Meryem Emre Aysin ◽  
Keyword(s):  
Learning Curve ◽  
Linear Models ◽  
Raw Materials ◽  
Analysis Data ◽  
Vital Role ◽  
Learning Curves ◽  
Cement Industry ◽  
Company Performance ◽  
Technological Learning ◽  
The Impact

The learning curve reflects the reduction in average costs as the company's cumulative production increases. These curves are utilized when measuring company performance, managing production processes, and planning. In terms of cost reduction and profitability, the impact of learning is particularly important. The learning curves have been traditionally used in industries. In this study, the learning curves concerning the cement industry are examined. The cement sector inherits a high export potential in Turkey. Additionally, it is the industry branch that supplies the raw materials needed by countries' construction industries. On the other hand, the construction sector is a leading sector that mobilizes other markets. This sector is a major contributor to production, investment, and employment and plays a vital role in the development of the country. This paper aims to make a detailed analysis of the learning curves regarding the Turkish cement industry at the regional level covering the 2000-2018 period. In order to realize this aim, the linear and cubic learning models have been applied and the technological learning values for regions from 2000 to 2018 have been calculated. For the analysis, data of 68 factories operating in the Turkish cement industry obtained from Turkey Cement Manufacturers' Association have been used. The estimated results suggest that cubic models explain technological learning better than the linear models. The results indicated that learning levels differed across regions and times. While the highest learning level was observed in 2004, the highest level of forgetting was recorded in 2018. Finally, we can state that the learning curve of the Turkish cement industry between 2000 and 2018 is convex.

scholarly journals United Kingdom Diabetic Retinopathy Electronic Medical Record (UK DR EMR) Users Group: report 4, real-world data on the impact of deprivation on the presentation of diabetic eye disease at hospital services

2018 ◽  
Vol 103 (6) ◽  
pp. 837-843 ◽  
Author(s):  
Alastair K Denniston ◽  
Aaron Y Lee ◽  
Cecilia S Lee ◽  
David P Crabb ◽  
Clare Bailey ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Diabetic Retinopathy ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Real World ◽  
Eye Disease ◽  
Inclusion Criteria ◽  
Data Set ◽  
Diabetic Eye Disease ◽  
The Impact

AimTo assess the impact of deprivation on diabetic retinopathy presentation and related treatment interventions, as observed within the UK hospital eye service.MethodsThis is a multicentre, national diabetic retinopathy database study with anonymised data extraction across 22 centres from an electronic medical record system. The following were the inclusion criteria: all patients with diabetes and a recorded, structured diabetic retinopathy grade. The minimum data set included, for baseline, age and Index of Multiple Deprivation, based on residential postcode; and for all time points, visual acuity, ETDRS grading of retinopathy and maculopathy, and interventions (laser, intravitreal therapies and surgery). The main  outcome measures were (1) visual acuity and binocular visual state, and (2) presence of sight-threatening complications and need for early treatment.Results79 775 patients met the inclusion criteria. Deprivation was associated with later presentation in patients with diabetic eye disease: the OR of being sight-impaired at entry into the hospital eye service (defined as 6/18 to better than 3/60 in the better seeing eye) was 1.29 (95% CI 1.20 to 1.39) for the most deprived decile vs 0.77 (95% CI 0.70 to 0.86) for the least deprived decile; the OR for being severely sight-impaired (3/60 or worse in the better seeing eye) was 1.17 (95% CI 0.90 to 1.55) for the most deprived decile vs 0.88 (95% CI 0.61 to 1.27) for the least deprived decile (reference=fifth decile in all cases). There is also variation in sight-threatening complications at presentation and treatment undertaken: the least deprived deciles had lower chance of having a tractional retinal detachment (OR=0.48 and 0.58 for deciles 9 and 10, 95% CI 0.24 to 0.90 and 0.29 to 1.09, respectively); in terms of accessing treatment, the rate of having a vitrectomy was lowest in the most deprived cohort (OR=0.34, 95% CI 0.19 to 0.58).ConclusionsThis large real-world study suggests that first presentation at a hospital eye clinic with visual loss or sight-threatening diabetic eye disease is associated with deprivation. These initial hospital visits represent the first opportunities to receive treatment and to formally engage with support services. Such patients are more likely to be sight-impaired or severely sight-impaired at presentation, and may need additional resources to engage with the hospital eye services over complex treatment schedules.

scholarly journals Lack of impact of nil-per-os (NPO) time on goal-directed fluid delivery in first case versus afternoon case starts: a retrospective cohort study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
R. Ryan Field ◽  
Tuan Mai ◽  
Samouel Hanna ◽  
Brian Harrington ◽  
Michael-David Calderon ◽  
...  
Keyword(s):  
Operating Room ◽  
Medical Center ◽  
Fluid Administration ◽  
Fluid Replacement ◽  
Primary Study ◽  
Start Time ◽  
Fluid Delivery ◽  
First Case ◽  
Patient Reported ◽  
The Impact

Abstract Background Goal Directed Fluid Therapy (GDFT) represents an objective fluid replacement algorithm. The effect of provider variability remains a confounder. Overhydration worsens perioperative morbidity and mortality; therefore, the impact of the calculated NPO deficit prior to the operating room may reach harm. Methods A retrospective single-institution study analyzed patients at UC Irvine Medical Center main operating rooms from September 1, 2013 through September 1, 2015 receiving GDFT. The primary study question asked if GDFT suggested different fluid delivery after different NPO periods, while reducing inter-provider variability. We created two patient groups distinguished by 0715 surgical start time or start time after 1200. We analyzed fluid administration totals with either a 1:1 crystalloid to colloid ratio or a 3:1 ratio. We performed direct group-wise testing on total administered volume expressed as total ml, total ml/hr., and total ml/kg/hr. between the first case start (AM) and afternoon case (PM) groups. A linear regression model included all baseline covariates that differed between groups as well as plausible confounding factors for differing fluid needs. Finally, we combined all patients from both groups, and created NPO time to total administered fluid scatterplots to assess the effect of patient-reported NPO time on fluid administration. Results Whether reported by total administered volume or net fluid volume, and whether we expressed the sum as ml, ml/hr., or ml/kg/hr., the AM group received more fluid on average than the PM group in all cases. In the general linear models, for all significant independent variables evaluated, AM vs PM case start did not reach significance in both cases at p = 0.64 and p = 0.19, respectively. In scatterplots of NPO time to fluid volumes, absolute adjusted and unadjusted R2 values are < 0.01 for each plot, indicating virtually non-existent correlations between uncorrected NPO time and fluid volumes measured. Conclusions This study showed NPO periods do not influence a patient’s volume status just prior to presentation to the operating room for surgical intervention. We hope this data will influence the practice of providers routinely replacing calculated NPO period volume deficit; particularly with those presenting with later surgical case start times.

An Objective Study of the Impact of the Electronic Medical Record on Outcomes in Trauma Patients

2012 ◽  
Vol 78 (11) ◽  
pp. 1249-1254 ◽  
Author(s):  
Paul J. Schenarts ◽  
Claudia E. Goettler ◽  
Michael A. White ◽  
Brett H. Waibel
Keyword(s):  
Length Of Stay ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Injury Severity ◽  
Unit Length ◽  
Traumatic Injury ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Delay In Diagnosis ◽  
The Impact

It is commonly believed that the electronic medical record (EMR) will improve patient outcomes. However, there is scant published literature to support this claim and no studies in any surgical population. Our hypothesis was that the EMR would not improve objective outcome measures in patients with traumatic injury. Prospectively collected data from our university-based Level I trauma center was retrospectively reviewed. Demographic, injury severity as well as outcomes and complications data were compared for all patients admitted over a 20-month period before introduction of the EMR and a 20-month period after full, hospital-wide use of the EMR. Implementation of the EMR was associated with a decreased hospital length of stay, P = 0.02; intensive care unit length of stay, P = 0.001; ventilator days, P = 0.002; acute respiratory distress syndrome, P = 0.006, pneumonia, P = 0.008; myocardial infarction, P = 0.001; line infection, P = 0.03; septicemia, P = 0.000; renal failure, P = 0.000; drug complication, P = 0.001; and delay in diagnosis, P = 0.04. There was no difference in mortality, unexpected cardiac arrest, missed injury, pulmonary embolism/deep vein thrombosis, or late urinary tract infection. This is the first study to investigate the impact of the EMR in surgical patients. Although there was an improvement in some complications, the overall impact was inconsistent.

Impact of interoperability of smart infusion pumps and an electronic medical record in critical care

2020 ◽  
Vol 77 (15) ◽  
pp. 1231-1236
Author(s):  
Roy Joseph ◽  
Sang Weon Lee ◽  
Scott V Anderson ◽  
Matthew J Morrisette
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Infusion Pump ◽  
Medication Administration ◽  
Absolute Difference ◽  
Infusion Pumps ◽  
Adult Intensive Care Unit ◽  
Incremental Value ◽  
The Impact ◽  
Smart Pump

Abstract Purpose To describe the benefits of smart infusion pump interoperability with an electronic medical record (EMR) system in an adult intensive care unit (ICU) setting. Summary In order to assess the impact of smart infusion pump and EMR interoperability, we observed whether there were changes in the frequency of electronic medication administration record (eMAR) documentation of dose titrations in epinephrine and norepinephrine infusions in the ICU setting. As a secondary endpoint, we examined whether smart pump/EMR interoperability had any impact on the rate of alerts triggered by the dose-error reduction software. Pharmacist satisfaction was measured to determine the impact of smart pump/EMR interoperability on pharmacist workflow. In the preimplementation phase, there were a total of 2,503 administrations of epinephrine and norepinephrine; 13,299 rate changes were documented, for an average of 5.31 documented rate changes per administration. With smart pump interoperability, a total of 13,024 rate changes were documented in association with 1,401 administrations, for an average of 9.29 documented rate changes per administration (a 74.9% increase). A total of 1,526 dose alerts were triggered in association with 76,145 infusions in the preimplementation phase; there were 820 dose alerts associated with 48,758 autoprogammed infusions in the postimplementation phase (absolute difference, –0.32%). ICU pharmacists largely agreed (75% of survey respondents) that the technology provided incremental value in providing patient care. Conclusion Interoperability between the smart pump and EMR systems proved beneficial in the administration and monitoring of continuous infusions in the ICU setting. Additionally, ICU pharmacists may be positively impacted by improved clinical data accuracy and operational efficiency.

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