A Custom-Developed Emergency Department Provider Electronic Documentation System Reduces Operational Efficiency

Area of Science:

• Emergency Medicine
• Health Informatics
• Healthcare Operations

Background:

• Electronic health record (EHR) implementation can enhance patient care but may disrupt emergency department (ED) efficiency.
• Custom electronic documentation systems (eDoc) are increasingly adopted to replace paper-based processes.

Purpose of the Study:

• To evaluate the impact of a custom ED provider electronic documentation system (eDoc) on operational performance.
• To determine if eDoc implementation affects patient length of stay and time to disposition.

Main Methods:

• Retrospective analysis of operational data from a single ED for 1-year periods before and after eDoc implementation.
• Analysis of 60,870 pre- and 59,337 post-implementation patient encounters.
• Multiple regression modeling to assess changes in length of stay and time to disposition, controlling for confounding variables.

Main Results:

• A significant increase in overall mean length of stay (6.3 minutes) and length of stay for discharged patients (5.1 minutes) was observed post-eDoc implementation.
• No statistically significant changes were found in length of stay for admitted patients or time to disposition.
• Unadjusted analysis showed increases in all measured outcomes, with length of stay for admitted patients increasing by 11.4 minutes.

Conclusions:

• The isolated implementation of a custom eDoc system was associated with increased overall and discharge length of stay in the ED.
• Findings suggest that custom electronic provider documentation may negatively impact ED throughput.
• Future research should explore strategies like reduced documentation, additional staff, scribes, or voice recognition to mitigate adverse effects.