Transient and Sustained Changes in Operational Performance, Patient Evaluation, and Medication Administration During Electronic Health Record Implementation in the Emergency Department

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“Study objective—Little is known about the transient and sustained operational effects of electronic health records on emergency department (ED) performance. We quantify how the implementation of a comprehensive electronic health record was associated with metrics of operational performance, test ordering, and medication administration at a single-center ED. Methods—We performed a longitudinal analysis of electronic data from a single, suburban, academic ED during 28 weeks between May 2011 and November 2011. We assessed length of stay, use of diagnostic testing, medication administration, radiologic imaging, and patient satisfaction during a 4-week baseline measurement period and then tracked changes in these variables during the 24 weeks after implementation of the electronic health record. Results—Median length of stay increased and patient satisfaction was reduced transiently, returning to baseline after 4 to 8 weeks. Rates of laboratory testing, medication administration, overall radiologic imaging, radiographs, computed tomography scans, and ECG ordering all showed sustained increases throughout the 24 weeks after electronic health record implementation. Conclusion—Electronic health record implementation in this single-center study was associated with both transient and sustained changes in metrics of ED performance, as well as laboratory and medication ordering. Understanding ways in which an ED can be affected by electronic health record implementation is critical to providing insight about ways to mitigate transient disruption and to maximize potential benefits of the technology.”[1]


The purpose of this study was to look at the short and long term changes that occurred during EHR installment in an emergency department. Specifically, the authors wanted to look at measures that included length of stay, patient satisfaction and amount of diagnostic testing, imaging and medication administration.


The study occurred at a medium sized emergency department that had an annual volume of 34,000 patients. ED staff was trained according to their job role. The study period lasted a total of 28 weeks with the first 4 weeks being pre-implementation for a baseline.


The length of stay increased for a period of 8 weeks after implementation. During the first two months after implementation, patient satisfaction decreased and then began to return to the baseline. Only the imaging orders remained constant through the implementation compared to the increase in diagnostic testing and medication administration.


The authors theorized the temporary decrease in patient satisfaction may have been related to the disruption in throughput and increase in length of stay. They also theorized that the increase in diagnostic testing and medication administration could be due to no clinical decision support being available.


This article provides important insight into what modalities can be affected when EHRs are implemented in the ED. Disruptment in the ED can lead to not only patient dissatisfaction, but I would think it would also cause staff dissatisfaction towards the EHR. Thus, it would be important to educate the staff prior to the implementation in what to expect moving forward.

Second Review


  1. Ward, M. J., Froehle, C. M., Hart, K. W., Collins, S. P., & Lindsell, C. J. (2014). Transient and Sustained Changes in Operational Performance, Patient Evaluation, and Medication Administration During Electronic Health Record Implementation in the Emergency Department. Annals of Emergency Medicine, 63(3), 320–328.