Impact of electronic health record implementation on patient flow metrics in a pediatric emergency department

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Implementing electronic health records (EHR) in healthcare settings incurs challenges, none more important than maintaining efficiency and safety during rollout. This report quantifies the impact of offloading low-acuity visits to an alternative care site from the emergency department (ED) during EHR implementation. In addition, the report evaluated the effect of HER implementation on overall patient length of stay (LOS), time to medical provider, and provider productivity during implementation of the EHR. Overall LOS and time to doctor increased during EHR implementation. On average, admitted patients’ LOS was 6-20% longer. For discharged patients, LOS was 12-22% longer. Attempts to reduce patient volumes by diverting patients to another clinic were not effective in minimizing delays in care during this EHR implementation. Delays in ED throughput during EHR implementation are real and significant despite additional providers in the ED, and in this setting resolved by 3 months post-implementation.[1]


The authors studied how sending less sick patients to an alternate clinic during the implementation of an EHR would help the ED workflow during this critical transition.


The emergency department sent patients to a temporary clinic during implementation of the new EHR. The electronic data from patients who came to the ED over 2 weeks were reviewed during the implementation process and again after 1 year. Metric data were also reviewed for the ED patients that visited the clinic for care before, during and after the implementation of the EHR. In addition, staffing was increased for 2 weeks during implementation. Metrics collected include length of stay (LOS) for admitted and discharged patient, number of patients seen, and time to provider.


Even though the average LOS and time to provider both increased during implementation, the study found that both returned to baseline after 3 months. Furthermore, “a new improved LOS steady state was achieved approximately 6 months post-implementation.”


The authors felt the EHR implementation was the cause of the negatively affected metrics. They felt this was due to the fact that no other major interventions were started during the implementation.


Clearly, sending less sick patients to an alternate clinic did not help prevent the negative impact that implementing an EHR in an ED had. Since the ED workflow needs to have the least amount of interruptions as possible in order to provide quality care to patients, more studies and research needs to be done in this setting.


  1. Kennebeck, S. S., Timm, N., Farrell, M. K., & Spooner, S. A. (2012). Impact of electronic health record implementation on patient flow metrics in a pediatric emergency department. Journal of the American Medical Informatics Association, 19(3), 443–447.