92 Does a Modified Direct Bedding Model Improve Door to Provider Time and Throughput in an Otherwise Resource Constraint Emergency Department?

Abstract

Methods: This observational study was performed at a level one tertiary care ED with 130,000 visits annually. Research assistants observed emergency physicians during ten hour shifts from May 2018 to December 2018. Assistants recorded the number of EMR alerts physicians received per patient chart, the types of alerts, and quantified the time physicians spent addressing the alerts. Assistants timed physicians with a stopwatch once a chart was open on EMR and finished timing once all orders were placed. Physicians were asked to give a score of 0 if the alert made no impact on clinical management and a score of 1 if it did. Data was dichotomized by resident and attending physicians. Fisher's exact test was used to analyze the variables.Results: 7 residents and 6 attending physicians participated in the study. 11 resident and 6 attending shifts were observed. Residents and attending physicians combined saw 153 patients, addressed 530 total alerts, and spent 62.35 minutes reviewing these alerts. Physicians averaged 3.46 alerts per patient and spent 0.41 minutes resolving each alert on average. Only 2.26% of overall alerts was clinically significant and changed management in 7 patients. 25% of the clinically significant alerts were allergy notifications. No variable was statistically significant between residents and attending physicians.Conclusion: Emergency physicians spend significant time resolving EMR alerts. However, alerts rarely change clinical management. Allergy alerts are the most common alert to change clinical management.