Jefferson Regional Medical Center Streamlines Emergency Department

The six physicians and 40 nurses in the busy emergency department (ED) at Jefferson Regional Medical Center provide emergency care to more than 50,000 patients a year. The department’s reputation for high-quality care stems partly from a paper chart system that “would be hard to beat from a time standpoint,” according to Dr. John Skowronski, ED medical director at JRMC. “But that doesn’t take into consideration the issue of legibility, and we suffered from a coding standpoint because of a lack of content.”

With Dr. Skowronski’s leadership and vision, ED physicians at JRMC are transitioning to an advanced clinical information system, robust physician documentation and orders at the bedside.

As part of a hospital-wide initiative to streamline care processes and create an integrated electronic medical record (EMR) for every patient, in 2002 the hospital began a phased implementation of Sunrise Clinical Manager™ and related modules throughout the continuum of care. According to Tom Harbuck, JRMC Executive Vice President, “We have configured this system to enhance our clinical 'practice.' And the more we use it, the more we see the endless possibilities for improving our outcomes and efficiencies.” In the spring of 2006, JRMC activated Sunrise Emergency Care™ allowing ED clinicians to raise care to a new level.

Tracking Board Improves Patient Flow
The first significant improvement came with the Sunrise Emergency Care Tracking Board, which enables clinicians to ascertain the status of patients from any desktop or mobile workstation, prioritize care for those who need it most, and match them to available resources.

“Prior to the Tracking Board, I was never sure how many patients we had in the waiting room,” said Dr. Skowronski. “Now I can view patient assessments from the triage area and I have a much better handle on what type of patients are presenting, even before they get into a room.”

The Tracking Board has also helped reduce patient wait time and maximize bed utilization. “Now we know that if we have 10 patients in the waiting room, we can shift our resources and move the patients through faster,” said ED Nurse Manager Michelle Powell, RN.

Customizable Documentation Enhances Care
The creative use of information technology is an integral part of JRMC’s strategy to connect care teams. The ED nurses were the first to benefit. Together, the nurses and analysts developed intuitive, clinician-friendly content optimized for the high-volume ED while accommodating the breadth of patient acuity. All nurses were trained on the flowsheets and were familiar with the new documentation within a single shift.

ED physicians’ utilization of electronic documentation is well-established across levels of patient acuity tailored to the complexity of their treatment. Dr. Skowronski works with JRMC’s clinical analysts to fine-tune the pre-configured content. “The beauty of the system is that I can essentially personalize the documentation templates to suit our style, so our coders and physicians are comfortable with it.”

The Benefits
After only four months of using the system, Dr. Skowronski and his group had documented several thousand patient notes. “The electronic charts provide us with quality and time-saving benefits,” Dr. Skowronski said.

The ED is the first JRMC department to go live with computerized physician order entry (CPOE). Dr. Skowronski works with clinical analysts on transforming paper order sets and protocols, and revamping the pharmacy catalogue. He’s excited by the time-saving opportunities afforded by CPOE and the use of Sunrise Emergency Care at the bedside. “The nurse can see new orders on the Tracking Board while I’m still in the patient’s room. It sets off that process a lot quicker. Sometimes the x-ray tech will bring the portable to the room while I’m still with the patient.”

Dr. Skowronski sees Sunrise Emergency Care helping improve clinician satisfaction. “There’s no question that the quality of documentation has taken a dramatic leap and revenues will reflect the changes.”