Operational Informatics

Computerized Physician Order Entry

We are currently studying the impact of computerized physician order entry (CPOE) on ED operations. clinical trials protocol

Scribes in the ED

We are currently studying the impact of scribes in the ED on physician charting, productivity, and reimbursement. 

Effect of Electronic Documentation on Clinician Productivity 

Our Lab is currently studying the effects of electronic documentation on clinician productivity and ED operations.

Presentations
  • Henning DJ, Horng S, McGillicuddy DC, Sanchez LD. Evaluating the Impact of Introducing an Electronic Charting System on Resident Productivity. National SAEM Research Forum. Boston, MA, Jun 2011.
Publications

ED Dashboard

The ED Dashboard is a custom built Emergency Department Information System at BIDMC. It is built in InterSystems Cache and integrates seamlessly with all other hospital information systems. It serves as the focal point for all clinical operations in the Emergency Department and implements a variety of advanced communication and reporting tools. The ED Dashboard serves as the foundation of a live-clinical testbed that makes the rest of our research possible.

Automated Emails Containing Daily Performance Metrics to Reduce Length of Stay 

This study evaluated the effect of a daily performance metric email to drive process improvement efforts to reduce ED LOS for patients who received general surgery consults. The results of this study suggest that a daily performance metric email is effective in reducing consultation times and LOS for surgical consult patients. Our results suggest considerable potential for this simple and inexpensive method of driving process improvement for ED consultations. 

Presentations 
  • Horng S, Pezzella L, Wolfe RE, Hurst JM, Nathanson LA. Root Cause Analysis Using Daily Performance Metrics Reduces ED Length of Stay for Surgical Consults. National SAEM Research Forum. Boston, MA, Jun 2011.
Publications 
  • Horng S , Pezzella L, Tibbles C, Wolfe RE, Hurst JM, Nathanson LA. Prospective Evaluation of Daily Performance Metrics to Reduce Emergency Department Length Of Stay for Surgical Consults. J Emerg Med. Epub 2012 May 24. PMID: 22633760

Passive Reminders to Reduce CT Utilization in the Emergency Department

This study determined whether a passive reminder indicating significant prior CT scan exposure decreases the odds of a CT requisition for that visit. Unfortunately, a passive reminder identifying patients with multiple prior CT scans was not associated with a significant change in physician ordering behavior for CT examinations.

Presentations 
  • Horng S , Reichenbach S, Nathanson LA, Fischer C, Sarwar A, Sanchez L. The Effect of a Passive Reminder on Computed Tomography Utilization in the Emergency Department. National ACEP Research Forum. San Francisco, CA, Oct 2011.

Rapid Communication of Critical Lab Results to Emergency Department Providers 

This project developed technology to improve patient safety by expediting the reporting of critically abnormal lab results to emergency department providers. We automated this process using the hospital's paging system, and closed the communication loop by using our ED Dashboard to record who acknowledged the critical result. We studied the effect this system has on the time it took providers to respond to hyperkalemia, which is an often life threatening electrolyte abnormality. This work was supported by a CRICO/RMF Patient Safety Grant.