| Description |
A set of database tools for logging and reporting the activities of the Emergency Department (ED) was designed and implemented as a subsystem of HELP, the Hospital Information System (HIS) at LDS Hospital in Salt Lake City Utah. Rather than documenting the ED's daily caseload on the traditional handwritten logsheet, the ED unit clerks entered the log data from their terminals at the nursing station. Integration with the central HELP database allowed the ED Log System to acquire information from a variety of sources, including Admitting, Medical Records and the ED unit clerks. In addition, integration made the log data immediately accessible for computerized decision support, and a variety of extradepartmental uses, such as Medical Records diagnostic coding and Trauma Registry development. An evaluation of the Log System showed: a) it functioned reliably, with an average usage of 101.7 data entry transactions and 14 reports per day; b) one week experience was aU that was necessary to master the use of the system, without specialized instruction or developer intervention; and c) night users took significantly longer (p < 0.05) to complete data entry transactions than did day or evening users. On average, data entry transactions required 1.33 minutes to complete. The system provided the ED with five different reports, allowing access to the log data on a patient specific basis, or summarized by arrival time, chief complaint or attending physician's ID. Telephone follow-up reports were also produced, which allowed the nursing staff to contact trauma patients conceming their recovery at home. Reporting the ED's activities to the Utah State Department of Health Emergency Medical Services (EMS) was accomplished using the Log System by mailing formatted ASCII files on 5 1/4 inch diskettes. The log data were then imported into the state's own computer, thus avoiding additional manual data entry. On average, the reports required 1.19 seconds per patient to retrieve the log data from the HELP database. An evaluation of the users' opinions of the system showed that both clerks and nurses agreed: a) that real-time data entry helped to eliminate errors in the recording process; b) that the data entry and reporting tools had been developed with consideration for the way their jobs were done, and for the department's information needs; c) that use of the system was easily learned in relatively little time; d) that access to valuable information had been improved by computerizing the log; and e) that the computerized log had a positive impact on the quality of record keeping and documentation in the ED. Despite their agreement on the issues listed above, clerks overwhekningly favored the computerized Log System, while the nurses preferred the paper logsheet. The successful implementation of the ED Log System represents a bench mark for the continued computerization of the ED at LDS Hospital. Ongoing efforts to develop decision support and charting applications will necessarily make use of the log data, and can only benefit from the lessons of the present study. |
