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January 21, 2008

Georgia Hospital Upgrades ED Operations to Eliminate Survey Stress
By Joseph Frey, RN
For The Record
Vol. 20 No. 2 P. 6

The Joint Commission is the nation’s predominant not-for-profit organization for setting and maintaining the highest healthcare system standards for quality care and patient safety. In January 2006, The Joint Commission announced that it would no longer give hospitals and health organizations advanced notice of on-site accreditation surveys. For years, The Joint Commission was concerned that hospitals were focusing too much on the success of their next survey rather than their next patient. With the implementation of unannounced visits, the commission has encouraged healthcare organizations to refocus their attention back on patients, patient processes, and operational systems.

The Joint Commission’s decision caused stress for hospitals throughout the country that were fighting to maintain proper procedures while also dealing with increasing patient visits in the emergency department (ED). In an emergency medicine setting, maintaining the proper procedures can be difficult, if not impossible, when traumas, illnesses, and other medical emergencies fill the department beyond capacity.

Georgia’s Athens Regional Medical Center was one facility feeling the pressure. In 2004, more than 50,000 patients visited its ED, with that number expected to reach 77,000 by 2010. As a result, by 2005, the medical center’s ED was running well over capacity. At the same time, The Joint Commission was moving closer toward approving unannounced site surveys. Athens Regional executives knew they had to implement a new ED system that would operate at a higher capacity as well as ensure that the hospital was properly maintaining The Joint Commission standards at all times.

After a long and thorough vendor search, Athens Regional chose to implement an ED information system (EDIS). With the technical and professional support of an EDIS, hospitals can streamline communications and improve the care process. As a result, hospitals can increase the bottom line and productivity. An EDIS is able to provide patient information management at many levels, including patient registration, triage, patient tracking, and physician and nurse documentation. Clinicians and patients alike benefit from EDIS implementation in the form of decreased patient wait times, increased face time between physicians and patients, improved charge capture, and greater employee satisfaction.

After much research, Athens Regional chose to implement Allscripts’ HealthMatics ED, citing its comprehensive user interface and history of successful implementations. Since the 2006 implementation of its EDIS, the medical center has experienced more efficient operations and increased employee satisfaction. Most significantly, it has been able to improve patient safety—the most important mission of both the hospital and The Joint Commission.

Streamlined Communication
Physicians and nurses at Athens Regional quickly noticed improvements in The Joint Commission adherence as the EDIS streamlined communication, making information readily accessible to ED employees. Physicians no longer had to wait for patient records to be transferred through departments, track down lab results, or locate who wrote illegible notes on patient records. All information became clear and readily available to be called up from any location.

Now, physicians can spend more time with their patients instead of chasing charts. In addition, relationships between the ED and its ancillary departments have improved because physicians, nurses, and lab technicians can communicate and transfer information more efficiently.

As a result, physicians are more confident during The Joint Commission site surveys because easy, immediate access to patient information ensures greater patient safety and improved operations within the department. Physicians are willing and able to answer questions from any auditing team regarding the accessibility of patient records and courses of care.

Patient Safety and Satisfaction
Although healthcare organizations throughout the country acknowledge the importance of The Joint Commission visits, they still cause stress for hospital employees and executives. Since the implementation of the EDIS, the staff at Athens Regional worry less about The Joint Commission reviews because the system guides physicians and nurses to maintain proper procedure and protocol for patient safety and privacy.

For example, an EDIS immediately flags a patient’s drug interaction history and allergies to make certain the chosen course of treatment is appropriate. Electronic flags are especially important in an ED, where patients may return for medical attention within days or even hours.

Before the EDIS implementation, ED doctors spent approximately 60% of their time on hospital dictations, a slow and costly process. Patients were returning to the ED before transcriptions had been completed. As a result, doctors were responding to patients’ medical needs without the availability of the most up-to-date records and notes from prior visits. Now, dictation time has been cut to zero because of voice-to-text editing. Since the EDIS records information immediately, doctors can respond efficiently and effectively to patients’ present needs, with a full picture of their past visit and treatment.

Patient safety has improved, and the hospital can now offer the best possible care whether the patient returns in one year or one hour. The system also contains flags to remind doctors of The Joint Commission, the Centers for Medicare & Medicaid Services, and HIPAA standards. As a result, Athens Regional maintains proper procedures that can withstand an unannounced site review.

Patient safety has also improved because information is more readily available to physicians and nurses alike. For example, admission room assignment time has been cut from an average of 60 to 90 minutes to just two to three minutes. Not only does this improve safety, but it makes patients happier.

Overall, patient safety has improved at the medical center since the physicians are spending more face time with their patients instead of chasing information necessary to make a timely disposition. Doctors are less stressed about The Joint Commission standards concerning safety because the technology keeps employees on track and confident that they are acting in the patients’ best interest with the necessary protocol.

In short, unannounced visits cause less stress because safety and quality are an everyday practice, not a practice demonstrated only when a survey is on the horizon.

Other Benefits
The EDIS has also helped the hospital improve billing. Before electronic databases were introduced, doctors and nurses worried about having enough documentation to defend charges, or that they recorded the wrong billing code. However, an EDIS immediately captures a charge based on the documentation and calls up the proper CPT code. This feature also helps ensure that patients are billed fairly and documentation is available in insurance disputes.

While Athens Regional’s ED continues to run over capacity due to its size and ever-increasing patient volume, the staff are now confident in their ability to maintain high standards in quality healthcare and patient safety. It is evident that this piece of healthcare technology has helped the medical center transform its operations for employees and patients alike. As The Joint Commission would agree, patient safety must be under constant review, not just on a few specified days of the year.

— Joseph Frey, RN, works in the emergency department at Athens Regional Medical Center in Georgia where he has been the assistant unit director for 15 years. Most recently, he was involved in the selection, customization, and implementation of the department’s electronic medical record.