Smart ED project (eAED) attains high frontline acceptance with impact on quality of documentation and reduction of risk of patient misidentification in emergency departments

Abstract Description

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Authors (including presenting author) :

Lui CT(1), Lee LY(1), Lau CL(1), Chan WL(1), Tang H(1), Cheng SK(2), Tang KT(2), Ma HM(2), Lit CH(2), Shih YN(2), Tong YHA(3), Wong WWY(3), Lau KK(3), Li CF(3), Kwong YO(3), Yu WM(3)

Affiliation :

(1) Department of Accident and Emergency, Tin Shui Wai Hospital (2) Department of Accident and Emergency, North Lantau Hospital (3) Information Technology and Health Informatics Division, Head Office

Introduction :

The corporate eAED project targets for creating smart emergency departments (ED) by digitalization and modernization of documentation and workflow. Objectives included both improvement in workflow efficiency, and also quality and safety enhancement including documentations and potential impact on correct patient identification throughout patient journey. With the revolutionalized workflow, frontline staff engagement is of paramount importance.

Objectives :

To evaluate the impact of implementation of eAED on incidence rate of patient misidentification in ED, and frontline staff acceptance of the eAED system

Methodology :

Data was retrieved from NTWC A&E patient misidentification incidents registry and AIRS database between April 2017 and March 2018. TSWH A&E had been adopting eAED workflow during the period while TMH and POH A&E served as control group with traditional workflow. Patient misidentification incidents were compared and contrasted between eAED and traditional workflow. An online survey to all clinical frontline doctors and nurses was conducted in November 2018 in NLTH and TSWH A&E with eAED implemented. The user acceptance had been evaluated in domains of Q&S, workflow efficiency and overall preference grading comparing eAED and traditional A&E workflow.

Result & Outcome :

The patient misidentification incidence rate in ED was 9.8 per 100,000 patient attendances in TSWH A&E with eAED while the figure was 20.3 in the control group with traditional workflow. Breakdown analysis revealed major reduction in incidents in post-consultation workflows and at the juncture of patient discharge. 52 frontlines participated the eAED survey with response rate of 38.5%. The survey revealed good user acceptance of the eAED system. 89% participants agreed better clinical documentation by eAED. The proportion of participants that agreed eAED would provide more accurate time capture, reduction in patient misidentification and missing documentation were 83%, 62% and 60% respectively. In the domain of workflow efficiency, 58% agreed eAED is more efficient than traditional workflow. 77% and 83% agreed that e-workflow and e-Patient list could facilitate the daily clinical works. The overall grading was better in eAED (median=7 in 10-point likert scale) compared to traditional workflow (median=6/10; p=0.023). The proportion of grading > 5 points were 79% and 61% for eAED and traditional workflow respectively. Both junior staffs and more senior staffs demonstrated homogeneity on the preference toward eAED.