Case Study: Emergency Department Downtime
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Case Study: Emergency Department Downtime
Many health care systems rely on the Electronic Health Record (EHRs). The most common constitutes used in the EHR includes the Electronic medical assistance record and clinical decision support systems. Emergency department tends to rely on the integrated EHRs to manage the nexus of patient inflow (Wretborn, Ekelund, & Wilhelms, 2019). The complex combination of high influx and patient with high acuity illness frequently cause the ED crowding. If the HER break down, there is a substantial increase in workload, limited access to patient data and frustration of staff and patients. In such an event, Nelson & Staggers (2018, p.346) argues that having multiple, overlapping systems working in a synchronized manner offers the most reliable solution to HER meltdown. In this paper, I argue that overhead communication during HER breakdown plays a significant role in implementing downtown procedures. The paper will be structured into four parts; using the Emergency Medical Downtime case study. Part one and two will be addressed using a component of the Downtime determinator. The next part will involve the documentation of my responses as an IT, manage end-user complain and communication plans and make changes to the assessment and plan to account for changes in the case study.
Component of the Downtime Determinator
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Memorandum
To: End Users-Clinical staff and Clinician
From: IT Department
Date:
Subjects: Unscheduled and Unplanned Downtime Event
I am writing to inform you that there has been unscheduled and Unplanned Downtime that occurred at 17:00. Attempts to reboot the system by the IT department in conjunction with the vendors help desk in the past 1 hour has been unsuccessful.
The cause of the Downtime is attributed to database corruption; you are advised to resort to the paper backup system for patient demographic and diagnosis for the next 8-10 hours. Clinician and staff member are advised to visit patient care and ancillary area to assist with downtime procedures and communicating the status of the situation and the plan in action.
When the system has been restored, all the staff member, technical team and clinical will receive communication through their email and phone call. In case of any inquiry kindly contact the IT help desk on level2truama@helpme.org or call IT on 555-555 hotlines.
End-User: Patients
One of the most crucial aspects of Downtime overhead communication is providing a patient with information on the status of the system. Functional EHR system within the emergency department increases the quality of patient care. However, in the event that the system is down due to technical malfunction, the patient tends to get frustrated due to the long duration of time spent using the paper backup system. Thus, constant communication to patients eases anxiety while the clinical visit to patient areas increases staff morale (Coffey, Postal, Houston, & McKeeby, 2016). Besides, the patient will be provided with inpatient and outpatient toolkits to ease the process of data collection and minimize on time spent. Patient at the Trauma centre was highly inconvenienced, but due to prompt communication, they appreciated the effort made by the IT department is working to resolve the existing problems.
Communication Plan
The primary goal of the communication plan is to minimize frustration, staff complains, and patient incurring adverse effects due to delayed service provision. Since technical are unpredictable, in case of discovery, immediate communication through email, template and phone calls should be implemented to the staff involved, such communication ought to originate from the IT department since it is their mandate (Nelson & Staggers,2018). Besides, hospital leadership should also take centre roles in minimizing and motivating the employees due to the impending workload. The communication plan should also include the activities that must be carried out before, after and during the incident. Such activities include identification by section of on-call EMT in the Trauma centre, creation of downtime contingency plan and checklist.
Data Elements
According to Nelson & Staggers (2018, p.22), data elements include information of one kind, such name, weight, age and their collective data that is defined for processing by EHR systems. In particular, EHRs system tends to use structured data elements to document patient information using controlled vocabulary rather than narrative text. The utilization of data element makes it possible to develop customized templates that match the clinical flow at the trauma centres and maximize data completeness and structure (Bush et al., 2017). Besides, the templates can be adjusted based on physician preference.
Demographic Data
Patient Name_________________________________________________________________
Date of Birth _____________ Age _______ Sex ______ Race _________
Address ________________________________________________
City __________________________ State/Zip ____________
Phone _______________ Email: _________________________________________
20 Data elements
1 .Serial Number………………
- Patient Insurance: ……………………………………….
3. Patient Medical History: ………………………………..
4. Patient Family Medical History:………………………………..
5. Patient Diagnosis: ………………………………………………6. Is the patient a smoker? ……………………………………………. - How many cigarettes a day?……………………………………………………..
- Patient Allergies: ……………………………………………..
- Present and past medications: ……………………………………
- Is the patient in the ER for? ……………………………………………….
- What are today’s symptoms: ……………………………………..
- How long have you been experiencing these symptoms? ……………………………..
Physician Information
13.Name:________________ Phone Number: __________________________
14.Any use of alcohol or drug substance: __________________________________
15 BP: ___________ PULSE: ____________ TEMP:_____________
- Emergency Contact: ___________________________________________
- Relationship: ___________________ Phone: ______________________
- Physician Notes: ______________________________________________
- Signature: ____________________________________________________
- Date:_______________________________________
Change to the Assessment
Hospital staff and the patients should be in constant communication about the situation at hand. The objective of the new personal time system was to give research facility results electronically to clinicians in basic consideration regions and in ED settings while the LIS or interface was still down. For stable patients in different units, the objective was to keep the turnaround times for morning attracts as near ordinary as could be allowed. The convention stressed correspondence among the IT group, the lab, and clinical staff, both previously and during personal time. The changes that could be made is having a backup system in place when the original systems are down. By having a backup HER system, this will protect the patients as well as the hospital.
Conclusion
The Downtime at the Trauma centre as a result of database corruption has had a significant impact on both the patient and the normal operation at the hospital. Thus, it is important for the organization to invest in disaster management and the use of third party service provider for back up services. The organization should also invest in the start of the art technology that is expense initial but in the long run, have reduced incidence of Downtime to technical malfunctions. Besides, carrying out technical diagnosis will help the reduced occurrence of downtimes while staff training help in effective implementation of the recovery plan.
References
Bush, R. A., Kuelbs, C., Ryu, J., Jiang, W., & Chiang, G. (2017). Structured data entry in the electronic medical record: Perspectives of pediatric speciality physicians and surgeons. Journal of Medical Systems, 41(5). doi:10.1007/s10916-017-0716-5
Coffey, P. S., Postal, S., Houston, S. M., & McKeeby, J. W. (2016, June 27). Lessons learned from an electronic health record downtime. Retrieved from https://perspectives.ahima.org/lessons-learned-from-an-electronic-health-record-downtime/
Nelson, R., & Staggers, N. (2016). Health Informatics-E-Book: An Interprofessional Approach. Elsevier Health Sciences. Retrieved from https://platform.virdocs.com/r/s/0/doc/582951/sp/42935513/mi/172680038?cfi=%2F4%2F8
Welborn, J., Ekelund, U., & Wilhelms, D. B. (2019). Emergency department workload and crowding during a major electronic health record breakdown. Frontiers in Public Health, 7. doi:10.3389/fpubh.2019.00267