The Operational Effects of Implementing Electronic Provider Documentation in the Emergency Department

Abstract

Background: EHR implementation may improve care quality in the ED. At our institution, we implemented a custom e-documentation system (eDoc) to replace paper documentation. No studies to date have characterized the effect of implementing e-documentation in the ED. Objective: To characterize the operational effects of implementing eDoc in our ED. Methods: We performed a retrospective analysis of data for 1-year periods before and after implementation. We used regression modeling and CEM to identify significant differences in outcome variables. Results: During the pre-implementation period, LOS was 4.29 hours, LOSa was 6.47 hours and LOSd was 3.49 hours; after implementation, LOS for these groups were 4.43 hours, 6.66 hours, and 3.52 hours. TTD was 3.00 hours before and 3.03 hours after implementation. Using regression analysis, there were no differences in outcome variables at 8 weeks; at one year, there were differences in LOS and LOSd patients of ∆+0.10 hours and ∆+0.08 hours. CEM analysis demonstrated a change of ∆+0.15 hours and ∆+0.17 hours for LOS and LOSd. Conclusions: In our study, implementation of e-documentation was associated with significant increases in LOS and LOSd. Though this increase may appear small, this additional time required for e-documentation has the potential to impact ED efficiency.