As emergency departments in the United States work to handle well over 100 million visits per year, hospitals are adopting new leading edge technologies and processes to boost their productivity and improve service.

Information technology (IT) has been one area of particular interest to ED management. Emergency Department information systems (EDIS) are being implemented or considered by many hospitals to replace paper based processes. Components of such systems include patient tracking, electronic medical records, computerized physician order entry (CPOE) and patient discharge modules. While there are comprehensive systems offering all of these functions, a number of products only provide some of these, such as patient tracking or discharge instructions.

Benefits from EDIS include better accessibility to information compared to paper. Once information is entered into the system, typically it can be immediately accessed by others who may be involved in the treatment of the patient. For example, the record of an ED patient who must be admitted, can immediately be made available to a nurse on the admission floor or to the patient’s personal physician to develop a treatment plan. EDIS can also speed the care process in the ED. ED physicians can enter orders for ancillary testing into the system and have those orders instantly communicated directly to the lab or radiology. This saves time over a paper based system where written orders are passed along to an ED clerk who then transmits the order to other departments. These systems also improve service by tracking throughput times to alert staff how long a patient has been waiting for a test result or the last time an ED staff member interacted with the patient.

A pioneer in the development of EDIS, Gregory A. Brown, MD, ED Medical Director at Kadlec Medical Center in Richland, WA said, "Implementation of an EDIS at Kadlec Medical Center had an immediate impact on work flow. Online physician and nurse charting eliminated the historical ED phrase ‘Who's got the chart?. The paper chase was gone. Previously handwritten notes were now legible, timed and instantaneously retrievable for all appropriate care givers. This step alone improved patient safety by facilitating rapid and accurate communication between the ED and the medical staff."

He continued, "The ED of the future will be a hub of rapidly collected data to support clinical decisions on patient care. ED physicians will use EDIS tools as 'data kiosks' or ED 'control tower'."

Other recent developments in IT systems include wireless networks which allow wireless enabled devices to access the EDIS without having to be hardwired to the system. This can reduce the cost of installation of a system versus having to install wires throughout the ED. It also provides additional mobility for ED staff. They can carry mobile PCs or handheld devices around with them instead of having to use a wired PC on a desk.

Wireless technology has enhanced the ability to improve other processes. Beside registration has become a new leading edge ‘best practice’ for EDs. Bringing the registration process to the patient instead of the patient coming to the registration station typically reduces the wait time for patients to be placed in a bed and be seen by a provider. Being placed in an ED bed faster is a key patient satisfier.

Automated dispensing systems provide security and the ability to closely track the use of pharmaceuticals and supplies. Such dispensing systems house prepackaged pharmaceuticals and supplies right in the ED allowing staff quicker access. These systems can also track usage of each item for automatic replenishment and for billing purposes.

On the clinical side of ED operations, both faster access to medical knowledge and the availability of new diagnostic devices are on the leading edge. Access to medical knowledge databases through an EDIS or handheld device allow physicians to instantly review the latest evidence based treatments for a specific disease or check drug interactions. Bringing this knowledge to the provider in real time can improve safety, the quality of care and speed ED processes, thus also improving the quality of service.

The use of bedside, portable ultrasound units by ED physicians is becoming more popular. These units provide ED physicians who have been trained in their use with a new tool for diagnosing certain clinical presentations without having to wait for the patient to make a trip to the Radiology department.

In talking about ultrasound, Mark W. Francis, MD FACEP, ED Medical Director for the Emergency Department at CGH Medical Center in Sterling, IL states, "ED ultrasound is the latest technological accessory available to emergency physicians. It enhances their ability to rapidly assess and treat selected patient problems at the bedside without the time consuming involvement of other hospital departments or personnel. Think of it as a new extension of the stethoscope."

Picture archiving and communications systems (PACS) while usually championed by the Radiology department, also have a positive impact on the ED. PACS systems allow quicker access to digital images such as CTs. Such systems also provide easier access to archived images from prior patient visits. Images can be accessed through the PACS almost instantly instead of waiting for medical records to search through a patient’s paper medical file to find and deliver prior imaging studies. The speed of retrieval of images through the PACS provides the ED physician with a more in-depth history for the patient which helps in deciding on a course of treatment for current complaints.

Looking even farther along the leading edge, one company has developed a robot which allows other physicians such as specialists to have a ‘remote presence’ in the ED. Through a mobile robot equipped with a video camera, microphone, video display and speakers, the remotely located specialist somewhere outside the ED can speak to and see a patient and ask questions in real time. The patient can see the physician on the video display of the robot and talk ‘face to face’. The robot also allows the remotely located specialist to look at images, or other diagnostic results to help decide whether their personal presence is needed for a patient.

Yulun Wang, PhD, CEO of InTouch Health, the developer of the robot commented, "InTouch Health's Remote Presence Robot, RP-6, enables physician specialists to more easily and immediately "beam in" to consult on emergency room patients, improving patient safety and the quality of care."

As EDs adopt more of these leading edge technologies, they hope that process times can be reduced leading to better and safer care, improved service and healthier, happier patients.