Capturing Patient Throughput Data in an ED
Capturing patient data for reporting purposes is an important tool utilized in the healtchare setting for a myriad of applications, and in todays age of real-time computerized charting, this data is expected to be immediately available and to be incredibly precise. While some of the data can be relatively easy to capture, there are times when extracting the data can be very complex. For instance, if your facility desires to have a report to measure the various times associated with a patients visit to the emergency department(ED), acquiring the needed times will not always be easily accomplished through a simple Structured Query Language(SQL) query to the database. It is this quest for patient throughput data that I will now discuss.
Before running a query to capture the data, you will first need to understand the clinical flow in the ED, and exactly what data you need for your purpose. Here are some standard points in a patients visit where throughput data will need to be captured.
- Time patient arrives
- Time patient seen in triage
- Time of first set of vital signs
- Time in waiting room
- Time patient arrives in room
- Time nurse sees patient
- Time physician sees patient
- Time physician places orders
- Amount of time patient waits for meds
- Amount of time patient waits for procedures/tests (labs, XRay, CT, MRI, etc.)
- Time that diagnosis made
- Time of dischage or admission
For this example, I will use McKesson Horizon Clinicals(HC) products as the applications in place in this ED. In a typical ED that is utilizing McKesson HC, they will use STAR for registration, Horizon Emergency Care(HEC) for patient charting, Horizon Order Entry(HEO) for physician and nursing order entry, and the McKesson patient Tracking Board to show the patients location and status.
Capturing the patients actual time of arrival in the ED can be very difficult, as in many facilities, the patient will first fill out paperwork, or a sign-in sheet which, since it is not performed electronically, the data is not capturable. To counter this, some facilities have implemented electronic kiosks with a touchpad for the patient to sign-in. This will allow for the electronic capturing of data. One method to resolve the issue of a paper-based sign-in is to ensure that the registration person use the time on the sign-in sheet as the arrival time that they enter into the STAR application, instead of the actual time that they enter the data.
Here is how and where I would capture the times needed.
- Time patient arrives - Entered by registration clerk in STAR
- Time patient seen in triage - Since the first thing performed in triage will be getting vital signs from the patient, use the time of the first vitals for time in triage. this data will be found in HEC
- Time of first set of vital signs - Captured from HEC charting
- Time patient arrives in room - captured from Tracking Board. You can use the time when the patient location on tracking board was changed from waiting room to the ED room they were assigned
- Time in waiting room - (Time to room - Arrival time)
- Time nurse sees patient - This could be captured from the nursing assessment/history in HEC, as this should be performed on the nurses first interaction with the patient.
- Time physician sees patient - This could be captured from the physician assessment in HEC
- Time physician places orders - Captured in HEO when phyician enters orders (whether in iForms or not)
- Amount of time patient waits for meds - (time when nurse administers meds as charted in HEC - Time whenmeds ordered in HEO)
- Amount of time patient waits for procedures/tests - (time when procedure started as charted in HEC - Time when procedure ordered in HEO) or (time when CT (or other) arrives in ED to pick up patient, as charted on the Tracking Board - Time when procedure ordered in HEO
- Time that diagnosis made - This timestamp is captured in HEC when physician select diagnosis
- Time of dischage or admission - Discharge time is captured in HEC, while time of admission can be captured from the patient Tarcking Board when their status is updated to an in-patient bed assignment.
Now that you know where to look for the data, how do you get it? I would reccommend using an application such as Business Objects to run queries to the database(s). In a typical set-up the Business Objects universe will include HEC, HEO and the Tracking Board. The data from STAR might need to be pulled from a seperate universe. Business Objects allows for the user to "drag-and-drop" various points of interest into a report anddoes the SQL in the backgroud for you. for data that is not easily grabbed, the user can add his own custom SQL to the report. Once the SQL report is complete, the needed math can be added to it to get the neccessary results.
Now that you have this data, what can you do with it? Well, one thing to do would be to demonstrate where delays in patient care take place or where excessive waiting takes place. Such examples would be (Time meds administered - time meds ordered). If the meds ordered where pain meds and it took 2 hours from the time when the meds were ordered to the time that the nurse administered them, then you have found a patient care issue. Another common timeframe to capture would be the time a patient haves to wait around for procedures to be performed (Time CT arrives for patient - Time ordered). If the patient is waiting in their room for hours for CT to pick them up, then you have a patient tying up a valuable bed in the ED, just laying around waiting to be taken to CT (or other). If you discover excessive waiting times, perhaps you could implement a policy where a patient is placed in a "holding room" after such procedures are ordered. This will open up the ED bed for another patient waiting for care, and reducing the time a patient spends in the waiting room goes a long way in improving patient satisfaction.
From these brief examples, you can see the value in capture pertinent patient throughput data in the ED. After you discover what information you need, first determine where it can be captured, then use the data appropriatly to get your results. If no time stamps can be found that meet your needs, then you can always add custom points to the Tracking Board to capture a variety of times.
If you have any questions or would like to speak to me about capturing patient data, just use the contact form on the "Contact Me" page and I will be sure to respond quickly.