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Using Electronic Medical Record Systems for Admission Decisions in Emergency Departments: Examining the Crowdedness Effect

Abstract

Many medical organizations have deployed electronic medical record (EMR) information systems (IS) to improve medical decision-making and increase efficiency. Despite their advantages, however, EMR IS may make less of a contribution in the stressful environment of an emergency department (ED) that operates under tight time constraints. The high level of crowdedness in the EDs itself can cause physicians to make medical decisions resulting in more unnecessary admissions and fewer necessary admissions. Thus this study evaluated the contribution of an EMR IS to physicians by investigating whether EMR IS leads to improved medical outcomes in points of care in EDs under different levels of crowdedness. For this purpose a track log-file analysis of a database containing 3.2 million ED referrals in seven main hospitals in Israel (the whole population in these hospitals) was conducted. The findings suggest that viewing medical history via the EMR IS leads to better admission decisions, and reduces the number of possibly avoidable single-day admissions. Furthermore, although the ED can be very stressful especially on crowded days, physicians used EMR IS more on crowded days than on non-crowded days. These results have implications as regards the viability of EMR IS in complex, fast-paced environments.

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Notes

  1. We chose the average as the threshold value for determining the crowdedness level over other alternative threshold candidates such as the median (consistent with other studies mentioned above). However, we tested the same regressions with a median threshold and found very similar results. We also tested several of other levels above the average (such as one and two standard deviations) and obtained very similar results.

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Correspondence to Ofir Ben-Assuli.

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Ben-Assuli, O., Leshno, M. & Shabtai, I. Using Electronic Medical Record Systems for Admission Decisions in Emergency Departments: Examining the Crowdedness Effect. J Med Syst 36, 3795–3803 (2012). https://doi.org/10.1007/s10916-012-9852-0

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  • DOI: https://doi.org/10.1007/s10916-012-9852-0

Keywords

  • Crowdedness in emergency medicine
  • Electronic medical record
  • Medical informatics
  • Medical decision-making