EDIS helps shrink door-to-doc times

Being able to track patients speeds upfront process

The ED at MetroHealth Hospital in Grand Rapids, MI, has achieved a door-to-doc time of 19 minutes with the help of an information system.

In addition, average length of stay (LOS) for discharged patients has dropped from 2.18 hours to 1.86 hours, and inpatient LOS is down to 3.55 hours from 3.98 hours with the ED Information System (EDIS) from Medhost of Addison, TX, according to Helen Berghoef, RN, MSN, the director of ambulatory services/ED at MetroHealth.

"The Medhost system has had a dramatic impact on all three of those [numbers]," she reports. "I might not go so far as to say we couldn’t have done it without it, but it certainly has been an invaluable tool."

In 2001, MetroHealth went live with the patient tracking component of the system, which also has discharge instructions and prescription writing. In 2003, the ED added a second component: nurse charting. This module has the ability to capture charges based on what the nurses are documenting. "Without a doubt, our goal was to be able to know what was going on with our patients all the time, in real time, and be able to look at the data retrospectively and quickly, without lengthy manual data collection," says Berghoef.

The system has helped their upfront process, notes Berghoef. When a patient comes to triage and is seen by the nurse or greeter, their information is immediately entered into the EDIS.

"Because the triage nurse has access to all that is going on in that department — and so does the charge nurse — the charge nurse already has the next patient assigned to a bed, so the triage nurse can finish up triage and get the patient right back to a room," says Berghoef. "They don’t have to make phone a call and talk to the charge nurse — which takes time."

In addition, Berghoef has put a registration person in triage. "Some say bedside registration is the be-all and end-all," she observes, "But we’ve found with this approach, we can do it all [triage and registration] in four minutes and not have to find another person to do registration. Plus, it’s very customer-friendly."

Managing the care process

The EDIS also has led to better management of the care process in the ED itself, says Berghoef. "Because all staff has access to what’s happening with all patients — including physicians — they can tell at a glance when there are delays with lab work or with getting a patient to X-ray," she notes. "Even our physicians will get involved in making things happen and keeping them rolling."

This emphasis affects the process up front as well, she emphasizes. "What you do in the back has a big impact, because if you keep things moving you are preventing bottlenecks, so you can keep these patients up front moving back," she explains. "If you have bottlenecks in the back, the impact goes to the front."

Another facet of the system that helps speed processes is its touchscreen technology, notes Craig Herrod, CEO of Medhost. "You can use a mouse and a keyboard, and the nurse at triage will often do that, but the bulk of the rest of the clinicians use the touch screen," he says.

A significant investment

How much does a software system like this cost? "Depending on the size of the hospital, you are typically talking anywhere from $350,000 to $600,000," Herrod says.

How can an ED manager cost/justify such an investment to administration? Herrod says the answer is the return on investment. "The ED managers get to talk with a bunch of customers who have hard numbers to share about what they are getting for their returns," he says.

Berghoef says, "If you consider that our return on investment was an incremental $50 per patient net, it would be pretty easy to cost justify this for a small or a large ED." (See the chart.)

Still, such an important investment requires a lot of homework. Herrod says, "The best way, first and foremost, is to immediately talk to some user groups on the web, as well as each company’s customers about their decision. Then, you should definitely include the IT people at the hospital, because they need to help drive the decision." It’s also important that you get an administrative "champion," he says. If the hospital is spending more than $10,000, it will be in the capital budget, Herrod points out. "Finally, create opportunities for vendors to come to your department so your staff can get their hands on the system," he says.

Sources

For more information on ED information systems, contact:

  • Helen Berghoef, RN, MSN, Director, Ambulatory Services/ ED, MetroHealth Hospital, 1919 Boston St. S.E., Grand Rapids, MI 49506-4199. Phone: (616) 252-7200.
  • Craig Herrod, CEO, Medhost, 5055 Keller Springs Road, Suite 400, Addison, TX 75001. Phone: (972) 560-3100. Fax: (972) 560-3900.