A Tech Transplant for the Emergency Room

It might be a great prop for the set of “ER.” But as an
organizational tool, the dry-erase board that helps emergency
doctors and nurses keep track of patients is as outdated as
using leeches as a cure-all. The big, white boards aren’t very
user-friendly either: patient anonymity is sacrificed; they’re
prone to human error and they’re tough to update when juggling
a lot of sick people.

by Joan Raymond Newsweek

Who better to figure out a solution than some techies with
medical degrees? That’s what happened at Boston’s Beth Israel
Deaconess Medical Center when three doctors put their heads
together to devise a new system. The result: an “electronic
dashboard,” a four-foot-wide, color-coded, wireless plasma
display to replace the Jurassic white board in Beth Israel’s
emergency department.

It’s a study in primary colors: red, blue
and green (with shades of pink and blue thrown in for patient
gender). The colors are geared to the severity of the complaint:
red for the most serious, green for less-urgent cases.

The doctors didn’t stop there. They completely rewired
Beth Israel’s new emergency department, which opened last
July. “That was a perfect opportunity to get in there and do
some things right,” says Dr. Larry Nathanson, a full-time
emergency doctor who led the team that developed the system,
at a cost of roughly $200,000. “So we jumped on it.”

A patient is first met by clerks who load his registration
data into a laptop. That information is immediately transferred to
the dashboard. As doctors examine patients (whose names
appear on the board as initials only), they enter their orders and
diagnoses into wireless laptops—again automatically updating
the dashboard. For example, “XR” indicates X-rays. That bar will
turn green when a patient’s X-rays are complete. “CC” stands for
chief complaint.

These terminals talk to the hospital’s Legacy
system—its central database—so personnel have immediate
access to medical histories, too. And each doctor is equipped
with a wireless phone that receives office calls—eliminating the
need for overhead paging.

Nathanson, who did fellowships in medicine at Harvard and
medical informatics at Beth Israel, plans to extend the use of
the dashboard to disaster-response teams. They currently keep
their records on paper, he says. Instead, data could be recorded
via satellite-networked laptops, providing real-time situation
updates to a “dashboard” at a central command post.

Such a
system could even provide immediate data analysis during and
after a disaster to help spot patterns that might suggest the
presence of biological or chemical agents.
For now, Nathanson, whose many hats include handling
clinical research and development for Beth Israel’s parent
company, CareGroup Health System, is still refining the new
technology to help reduce overcrowding in emergency
departments.

With too many patients, too few nurses and not
enough beds, hospitals like Beth Israel are often forced to close
their doors for several hours, and “divert” patients to other
hospitals.

According to Nathanson, the dashboard has already
reduced the number of hours during which Beth Israel had to
divert patients—it dropped to 40 hours during a recent six-month
stretch, compared with an average of more than 450 hours at
other nearby facilities over the same period. And Nathanson
estimates staff has cut out 30 minutes of wasted time per shift
searching for all the information that’s needed to treat or release
patients.

For the 60,000 patients who come to Beth Israel’s
emergency department every year, it can also save a few hours
of waiting time. “I can actually spend more time with my
patients now,” says Nathanson. “That’s good medicine.” And
that’s just what the doctor programmed.

—Joan Raymond

http://www.msnbc.com/news/741058.asp