California (LACUSC) ED, the Rand Schrader HIV clinic, and the LA County Office ... Cincinnati, OH; Carl H. Lindner College of Business, University of Cincinnati,.
Research Forum Abstracts advocate routine HIV screening in all health care settings including emergency departments (ED). In an effort to increase routine testing in inner-city patients, we designed and implemented the “R/O HIV in the LAC⫹USC ED” program. Methods: In March 2011, the Los Angeles County⫹University of Southern California (LAC⫹USC) ED, the Rand Schrader HIV clinic, and the LA County Office of AIDS Programs & Policy partnered to implement a non-targeted HIV screening and linkage-to-care program. LAC⫹USC is the largest public, safety net hospital in California. The ED sees 180,000 low-income, predominantly Latino patients annually. In one section of the ED, adult patients able to provide verbal consent were offered opt-out HIV testing using a rapid oral swab. Dedicated HIV screening personnel performed screening. Patients were not eligible for testing if they were: 1) Known HIV positive 2) Critically ill/ altered mental status 3) Non-English non-Spanish speaking. Positives who screened positive via the rapid oral swab were confirmed with western blot. Although not re-tested/ screened, known HIV⫹ patients were queried regarding their current engagement in care. Newly diagnosed cases and known HIV⫹ patients not currently in care met with an HIV specialist in the ED who scheduled a follow-up visit. We defined a successful linkage to care as the patient returning for their scheduled appointment. Results: Although this program in ongoing, in this abstract we report on data gathered in the first year of R/O HIV in the LAC⫹USC ED. Thus far, a total of 6,940 ED patients were offered non-targeted HIV testing, and 4,877 have been tested (opt-out rate 15.6%). Through R/O HIV in the LAC⫹USC ED, we have identified 25 cases of newly diagnosed (0.51%) HIV, and 174 cases of previously diagnosed HIV (47 out of care). An HIV specialist met with all newly diagnosed and known positive cases out of care, and through this we were able to successfully link 90% of newly diagnosed cased with care and re-link 78% of previously diagnosed patients. Conclusion: We implemented a successful non-targeted ED-based HIV screening and linkage program at a public hospital. Of note, our-opt out rate was low at 15.6%. We identified 25 cases of newly diagnosed HIV and 47 cases of previously diagnosed cases of HIV currently out of care. We were able to successfully link the vast majority of these
65 EMF
The Impact of Electronic Health Record Implementation on Emergency Department Operations
Ward MJ, Froehle C, Hart KW, Collins SP, Lindsell CJ/University of Cincinnati, Cincinnati, OH; Carl H. Lindner College of Business, University of Cincinnati, Cincinnati, OH; Vanderbilt University, Nashville, TN
Study Objectives: To determine the impact of electronic health record implementation on emergency department (ED) operations, including throughput, billing, medication administration, laboratory and diagnostic testing. Methods: This retrospective, observational study was performed at a suburban academic ED in Cincinnati, OH with annual volume of 33,000 patients. Institutional review board approval was obtained. Prior to electronic health record implementation a combination of electronic trackboard and paper charting were used for documentation and test ordering. A comprehensive electronic health record was then implemented hospital-wide. Data were obtained for one 4-week period before and 6 4-week periods after electronic health record implementation. Median service times with 95% confidence intervals, medication and testing rates and proportion of visits billed at level 5 (Current Procedural Terminology code 99285) were calculated. Results: All median service intervals (arrival-bed, bed-clinician, cliniciandisposition, disposition-exit, total length of stay) were increased for 8-12 weeks after electronic health record implementation. Total length of stay increased from 185 minutes (95% CI 179-192) to 231 minutes (95% CI 224-239) in the 4 weeks after implementation and decreased to 163 minutes (95% CI 157-168) by the 6th 4-week period after implementation. Testing, imaging and medication administration increased after implementation (Table). The proportion of visits billed at level 5 temporarily declined, but returned to baseline by the 6th period, reduced computed tomography (CT) rates were sustained after implementation. Conclusion: There were both temporary and sustained effects of electronic health record implementation on ED performance, test utilization and medication administration. Temporary change tended to resolve within 8-12 weeks. Some reductions in test utilization were seen (CT imaging) but laboratory testing and medication administration otherwise increased, perhaps reflecting the ease of ordering using the electronic health record. This may also have contributed to an overall increase in the length of stay. Further study of the electronic health record implementation process is necessary to understand whether these findings are generalizable, whether the degree and duration of disruption are characteristic of changes in ED systems, and whether there are strategies that can ameliorate the temporary disruption associated with electronic health record implementation.
Volume , . : October
4-week period reflects time from electronic health record implementation. For example, “-1” indicates one 4-week period prior to implementation, “1” represents the first period after implementation, “2” represents the 4-week period after implementation.
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Abstract Withdrawn
Impact of 12-lead ECG Wireless Transmission on Hospital STEMI Activations
Killeen JP, Vilke GM, Dunford JV, Fisher R, Pringle J, Castillo EM, Chan TC/University of California, San Diego, San Diego, CA; San Diego Emergency Medical Services, San Diego, CA
Study Objectives: We sought to evaluate the impact of wireless transmission of out-of-hospital field 12-lead electrocardiograms (ECGs) to hospital emergency departments (EDs) for potential ST elevation myocardial infarction (STEMI) patients. In particular, we focused on the impact of wireless field ECG transmission on emergent cardiac catheterization laboratory (cath lab) activation rates and times. Methods: We conducted a multicenter, before-after study at 3 area STEMI receiving hospitals (academic urban medical center, ED census of 40,000; community hospital, ED census of 27,000; and federal military hospital, ED census of 50,000) comparing STEMI measures during a 6-month period after implementation of community-wide ECG wireless transmission to hospitals from the out-of-hospital field (post-ECG), with a 6month period prior to the ECG wireless implementation (pre-ECG). In the pre-ECG period, paramedics obtained field ECGs on all appropriate patients with complaint of chest pain or shortness of breath. Paramedics called for cath lab activation solely based on computer interpretation of the ECG. In the post-ECG period, the field ECG was transmitted wireless via 3-G cellular network and Internet to the hospital ED for viewing by ED and cardiology staff prior to patient arrival. The proportion of field cath lab activations and false-positive activations (activations for patients found not to require an immediate intervention) for all out-of-hospital patients with field ECGs were compared before and after ECG wireless implementation using a chi-square test and Fisher’s Exact test, respectively. Median door-to-intervention time was compared using a MannWhitney U test. Results: During the pre-ECG period, there were 500 patients who had a field ECG obtained, of whom 40 cases resulted in a call to activate the cath lab for STEMI (8.0%). During the post-ECG period, there were 594 out-of-hospital patients who had a field ECG obtained, of which 12 cases resulted in activation of the cath lab after wireless ECG transmission (2.0%) (p⬍.001). The false positive activation rate was lower after wireless transmission was implemented, but was not statistically significant (25.0% in the preECG period versus 16.7% in the post-ECG period; p⫽.708). Median door-tointervention time was not significantly different between the pre- and post-ECG periods (57 versus 64 minutes, p⫽.122); however, 100% of all door-to-intervention times were less than 90 minutes during the post-ECG period, compared to 82% during the pre-ECG period. Conclusion: In this initial study at 3 cardiac receiving centers within a single region, wireless out-of-hospital ECG transmission resulted in fewer emergent cath lab activations from the field and fewer false-positive activations for non-STEMI patients with no change in door-to-intervention time.
Annals of Emergency Medicine S25
