Trying to find new ways to improve ED metrics? The answers probably aren’t in those same old EHR reports.
Emergency medicine leaders know that to solve a problem, you need to identify its cause. While electronic health records (EHRs) hold important clues to solving problems, they usually can’t provide the level of granular data required for real process improvement. That’s because EHRs use operational databases designed to collect and store data.
In contrast, d2i’s data warehouse is designed for analytics. Our analytics are also refined and are created continuously as new learning, questions, and evidence-based practices emerge. Our health care analytics solutions delve below the surface to find out exactly where problems are encountered in the patient journey.
Here are just some of the areas in which EHRs may fall short on providing the needed data story.
Leaving Without Being Seen
Leaving without being seen (LWBS) is an indicator of ED overcrowding, patient dissatisfaction, and potential adverse outcomes. It’s a heavily monitored metric and most ED leaders routinely run EHR reports and know their LWBS rate. But, this number alone doesn’t even begin to pinpoint root causes or fuel improvement efforts. Additional data points that help clarify the picture include:
- ED volume and arrival trends by day, week, month, or year: These figures help identify patterns of demand and supply, and how staffing and resource adjustments can be made accordingly.
- Segmented ED wait times: Breaking down wait times from arrival to triage, triage to bed, bed to provider, provider to disposition, disposition to departure, and admission order to inpatient bed can help pinpoint bottlenecks and inefficiencies, informing action plans.
- Throughput metrics downstream from the ED: It’s important to keep track of factors that increase wait times, including average length of stay, delayed discharges, capacity in community long-term care and mental health facilities, as well as numbers of patients boarding in the ED.
A readmissions rate, like a LWBS rate, doesn’t tell anyone much without context. It is an outcome, or end-process measure, and doesn’t give any true insight into how it came to be. Readmissions happen for any number of reasons, and no organization’s improvement plan will look exactly the same.
The following are some data points that interact with and influence each other in complex ways, something that d2i’s Emergency Medicine Performance Analytics carefully unravels to find root causes:
- Medical and population health factors: Factors including age, chronic diagnoses, procedures performed at the hospital, comorbidities, medication usage, and previous hospitalizations all affect a patient’s recovery and risk of complications. The more patients there are with chronic diseases and frequent illnesses, the higher the risk of readmissions.
- Discharge factors: Factors such as timing, destination, planning, communication, education, and follow-up all help determine whether a transition of care is effective, providing continuity and adherence to treatment in the best possible care setting.
- Social factors: Socioeconomic status, living situations, social support, health literacy, and access to care all help shape a patient’s ability to cope with illness, to self-manage, and to seek help when needed.
Readmission prevention needs to be a carefully orchestrated combination of interventions that best fit the patient population. To find the right combination, d2i brings out the nuances within the mountains of data that make it meaningful and above all, actionable.
Just hurry up already, right? Not so fast. The real picture behind this figure is much more complex. Do you need more providers or a better triage process? Or more beds?
To break down this ED throughput measure, it’s clear once again that a lot more data points are needed. Some of the things that d2i can help with are:
- ED volume and arrival trends by day, week, month, or year: It is always important to match demand with capacity as closely as possible to maximize available resources.
- Triage model and systems: These have different impacts on door-to-provider times, but not every model fits every organization. d2i works with many organizations of all sizes and has insights into which methods deliver results under different circumstances.
- Number of physicians, and patients per hour per physician: It might seem obvious that adding more physicians would decrease door-to-provider times, but other factors can be involved. These include process efficiencies, documentation burden, and administrative tasks. Determining which tasks are taking up the most physician time can help find areas for targeted workflow and EHR improvements.
- ED occupancy and mode of arrival: Having a high occupancy rate in the ED and a high proportion of patients who arrive as walk-ins or by private vehicle increases door-to-provider time because ambulance patients see providers earlier. Examining these patterns can reveal bottlenecks and delays that can be tackled with a different staffing mix or workflow.
How EHRs Fall Short
EHR systems are designed primarily to collect and store information, not necessarily provide business intelligence and data analytics. While EHR data is an essential data source, it is not curated for clinical operational improvement efforts. It must first become contextually meaningful and easily accessible. This requires the data to be integrated, cleaned, normalized, and augmented so that it can be provide actionable insight.
d2i stands out by merging data from diverse EM-related sources, enhancing standard operational and clinical metrics with extensive context. With over 40 million unique patient encounters, 10 million annual additions, and 9 billion data points, d2i offers the customization and detail required to create dashboards organizations are finding the most helpful.
d2i can help you dust off your EHR and make it work for you the way it should, by painting the picture of what is actually happening and fueling the actions needed to make a difference. For a demonstration and answers to your questions, contact d2i’s experts today or get an under-the-hood look by requesting a demo.