Electronic records blamed for rising ER waits

COLUMBUS, Ind. (AP) - Patients' lengths of stay in Columbus Regional Hospital's emergency department doubled in late June during a switch to an electronic records system, and times are still longer than usual despite improvements, hospital officials said.

The emergency department, which had used a paper system for recording patient information, switched to an electronic system the week of June 24. The hospital, as a whole, is switching to a new electronic health records system to meet the requirements of the 2009 economic stimulus legislation, which provided incentives for using electronic health records.

The benefit of electronic health records is that patient information has to be entered only once and can be shared by the various departments of the hospital, said Ron Latta, the hospital's information services director.

Before the switch, the average stays for the department's fast track and acute care patients were well below the national average, said Carolyn O'Neal, director of nursing. Fast track patients — those who have less severe illness that usually would be treated at a physician's office — averaged 2 hours, 25 minutes. Acute care patients — those with more severe conditions — averaged 2 hours, 32 minutes.

The week of the switch, the times jumped to 4 hours, 41 minutes for fast track and 4 hours, 13 minutes for acute care patients.

"When you are writing on a piece of paper that you've used for as long as you have been here, you can do it quickly. When you move to electronic, the staff had to be very careful to make sure they did things accurately," O'Neal said.

As the staff has become more familiar with the new system, stays have become shorter, O'Neal said. Currently, fast track patients average 2 hours, 39 minutes and acute care patients 3 hours, 10 minutes.

"We don't like the waits, the physicians don't like it, the patients don't like it," she said.

Extra nurses were used to assist patients in the emergency department during the switch but then were scaled back when lengths of stay grew shorter. However, more are going to be added in an effort to bring the times down to the pre-electronic record marks, O'Neal said.

The hospital's physician and nursing leadership also are examining the electronic system to identify issues that hamper efficiency and achieve solutions, Latta said.

The longer stays prompted more complaints than usual, but many patients also were understanding, O'Neal said. Handouts were given to patients explaining the switch, she said, and messages about it were shown on the digital screens in the hospital.

Jason Palmer, the emergency department nurse manager, said patients with life-threatening conditions, such as chest pain, stroke symptoms or not breathing well, were and still are seen immediately. And O'Neal said the hospital's ability to insert heart catheters faster than the national standard didn't change.

But patients with less-severe problems, like ankle sprains, sore throats and ear aches, tended to wait longer, Palmer said.

One way patients can be seen faster, Palmer said, is if they know the walk-in hours for their family physicians and pediatricians and try using those before coming to the emergency department.