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The impact of electronic health records on care of heart failure patients in the emergency room

Objective
To evaluate if electronic health records (EHR) have observable effects on care outcomes, we examined quality and efficiency measures for patients presenting to emergency departments (ED).

Materials and methods
We conducted a retrospective study of 5166 adults with heart failure in three metropolitan EDs. Patients were termed internal if prior information was in the EHR upon ED presentation, otherwise external. Associations of internality with hospitalization, mortality, length of stay (LOS), and numbers of tests, procedures, and medications ordered in the ED were examined after adjusting for age, gender, race, marital status, comorbidities and hospitalization as a proxy for acuity level where appropriate.

Results
At two EDs internals had lower odds of mortality if hospitalized (OR 0.55; 95% CI 0.38 to 0.81 and 0.45; 0.21 to 0.96), fewer laboratory tests during the ED visit (-4.6%; -8.9% to -0.1% and -14.0%; -19.5% to -8.1%) as well as fewer medications (-33.6%; -38.4% to -28.4% and -21.3%; -33.2% to -7.3%). At one of these two EDs, internals had lower odds of hospitalization (0.37; 0.22 to 0.60). At the third ED, internal patients only experienced a prolonged ED LOS (32.3%; 6.3% to 64.8%) but no other differences. There was no association with hospital LOS or number of procedures ordered.

Discussion
EHR availability was associated with salutary outcomes in two of three ED settings and prolongation of ED LOS at a third, but evidence was mixed and causality remains to be determined.ConclusionsAn EHR may have the potential to be a valuable adjunct in the care of heart failure patients.

Abstract
Connelly, Donald P.; Park, Young-Taek; Du, Jing; Theera-Ampornpunt, Nawanan; Gordon, Bradley D.; Bershow, Barry A.; Gensinger, Raymond A, Jr.; Shrift, Michael; Routhe, Daniel T.; Speedie, Stuart M., J Am Med Inform Assoc, 19(3), 334-340, DOI: 10.1136/amiajnl-2011-000271

More bibliographic information.

15 November 2011 | Categories: Science | Country: United States | EHR: EHR, EHR USA | Tag(s): Chronic Heart Failure, Efficiency, emergency, Quality
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