Emergency department physicians transmitted information on foot 20 years ago.
In the middle of treating a patient, doctors had to leave their department to locate medical records, rifle through papers or leaf through textbooks to find answers for diagnosis and treatment. Today they locate that information within seconds using a computer that requires no more than a few mouse clicks.
At Rochester General Hospital’s new B. Thomas Golisano Pavilion and Emergency Center, better computer accessibility is at the center of a new information technology infrastructure that keeps physicians, technicians and nurses from having to leave the room.
With more workstations more liberally distributed, caregivers can key in information, vital signs, and other patient data at the bedside instead of waiting for an available workstation in a central location.
"The ultimate thing is going to be more computers for us to use," said Keith Grams M.D., RGH’s chief of emergency services. "When you’re dealing with an older facility, built when computers were just coming on, there was never really space for computers.
"As time went on, they have become integral to patient care."
For the last couple of years, RGH’s emergency department has been using software to manage patient information and department processes. The program, Medhost, is the repository for all physician notes and patient-related data. With more computers, the capability of Medhost can expand in parallel. X-ray viewing is one example.
"For us to view radiographs before, there were only certain workstations within the department to use, roughly five to six workstations total. So the (care) provider would have to run around to get to that station," Grams said.
But with new software add-ons, data such as radiographies will be accessible through Web-based programs, allowing physicians to consult them on any computer.
"There are some limitations," Grams said. "The resolution is not as good, for example, but you’ll be able to show patients their X-ray right in the room."
Performing radiography is another improvement in the new emergency center, through a move from computerized radiography to digital, with a new Carestream digital X-ray room.
Derrin Connor, radiology technician at RGH, said that besides offering faster processing time for digital X-rays, the new technology especially is helpful because in operation it is so similar to conventional methods.
"It’s configured the same way as an X-ray room, which for someone like me who has been in X-ray for 23 years, I can go in and use it without needing very much training," Connor said. "Yet, because everything is set up as digital, we’ll no longer have to carry around our cassettes."
Reducing time in communication and processing was key to IT layout in the new center. Shaving processing time for X-rays and travel time to workstations can speed the movement of patients.
"Images take about three seconds to become available, versus 60 to 90 seconds," Connor said. "So you’re saving a good percentage of time off each case, which should increase turnover for us."
Emergency department patient loads at RGH vary from year to year, but in 2009 the hospital is on track for 93,000. The existing emergency department was built to admit 50,000 to 60,000 patients a year, Grams said.
The average daily volume of patients in the second quarter of 2009 was 267. This summer, it was closer to 260 a day, but that number is expected to grow.
"Anytime you open a new place, you usually do see in the neighborhood of 5 to 10 percent volume growth," Grams said. "It depends on our flu season, but we are anticipating another growing year."
The number of physicians in the emergency department at any one time also varies, but for children it generally includes one pediatric physician in addition to two midlevel practitioners.
"As far as providing medical care in the adult emergency department, there are three physicians plus one mid- level, and that flexes up to four physicians plus three midlevels during the evening hours," Grams said.
To make the most out of existing human resources as patient volume grows, telemedicine might provide a means to improve treatment time.
In other areas of the country, including Vermont, California and Arizona, emergency departments increasingly are using specialized software in conjunction with Web cams to improve communications with emergency medical services. The idea is to route patients more efficiently and prepare for them more effectively.
To institute a similar service at RGH, Robbin Dick M.D., the hospital’s outgoing chief of emergency services, has been co-developing a system with Cindy Gordon, a registered nurse specializing in telehealth-a Web-based means by which specialists consult with patients through an on-site caregiver.
When telemedicine is used by emergency departments, Dick explained, patients are more apt to get the right care faster, since doctors can see out into the field.
"As you know, EMS accounts for a significant amount of transports throughout the city every year," Dick said. "Some patients may or may not require transport. Some patients may require more urgent intervention than may be currently done, because it’s required based on recommendations from the ED physician.
"So if EMS had video links to the emergency department, there could be either alternate transports available to a non-urgent care area or institution of therapy earlier in the field, based on a patient’s presentation."
In the case of a car accident, for example, physicians able to see the wreck and the victims could better ascertain the severity of the injuries before the patients arrived at the hospital.
"Is there a potential for a splenic injury or liver injury, or brain injury? This may result in a change in therapy and readying a team in the emergency department prior to that patient’s arrival," Dick said.
The emergency department could prepare better for incoming patients and reduce the confusion that often occurs, especially after major accidents such as bus crashes.
Meant to extend specialized health care to rural areas where it is lacking, telehealth has already been used at RGH with specialized software and Web cams that enable specialists to treat patients who otherwise might forgo treatment or never know they needed it, Gordon said.
She has helped institute the technology with caregivers at outpatient clinics, coordinating with RGH specialists who consult with the caregivers via Web cam. Applying the same methods to the ED, Gordon said, seemed like a logical evolution for the program.
While still in its infancy, the program is a means to improve communication and responsiveness, she said, and the technology itself is not new.
"You see the same thing elsewhere," Gordon said. "Police officers can pull up any information they want when they hand out a traffic ticket. It’s the means to be connected in real time, to be able to get the information people need to so they can react appropriately."
The technology can help to streamline the emergency room experience, and that, officials explain, will benefit the patient more than anyone else.
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