CASE STUDY: Analyzing Emergency Department Outcomes

Challenge

Emergency Department process metrics, which measure how efficiently patients are seen, treated, and then admitted, transferred, or discharged, are critical to hospitals’ reimbursement from public insurance programs. Therefore, hospital executives often employ innovative strategies to improve the flow of patients through this process. The Chief Medical Officer of VSC’s client, a Community Hospital, which has an annual ED volume of ~30,000 patients, implemented one such strategy, hiring medical scribes to partner with ED physicians during the busiest hours each week to take over administrative responsibilities—tasks like documenting patient clinical information and entering follow-up orders. Our client hypothesized that the scribes would allow doctors more time to manage and treat patients, improving patient flow and its associated metrics. VSC was engaged to develop and implement a quantitative evaluation of the intervention.

Intervention

VSC conducted a non-experimental investigation that involved analyses of EMR data. The units of analysis were the clinical encounter and the patient. The population included all ED patient encounters that took place over a 12-month period, 6 months prior to the employment of scribes and during the 6-month scribe trial period. The study outcomes were Agency for Healthcare Research and Quality process and performance measures and throughput metrics. Explanatory variables (predictors) include the presence of a medical scribe associated with a given encounter, patient-level variables, temporal factors, organizational factors, and related laboratory/diagnostic variables.

 

VSC Services included:

  • Study Design

  • EMR Data Extraction

  • Risk-Adjustment

  • Theory-Driven Variable Selection

  • Advanced Quantitative Data Analytics

  • Reporting to Inform Quality-Improvement

Results

Our analysis determined that the presence of a medical scribe did not result in statistically significant reduction in physician-to-disposition time or overall length of stay; in fact, we found a statistically significant increase for both measures. Reductions in throughput metrics were minimal and typically did not involve scribe involvement (i.e., arrival to room, disposition to depart). Our analyses were presented to c-suite personnel and were used to inform quality improvement efforts and staffing decision-making at the Hospital.