A. N. Kothari1,3, R. H. Blackwell3, R. M. Yau3, V. Chang2,3, M. A. Zapf2,3, T. Markossian2, G. N. Gupta3, P. C. Kuo1,3 1Loyola University Medical Center,Department Of Surgery,Maywood, IL, USA 2Loyola University Chicago Stritch School Of Medicine,Maywood, IL, USA 3Loyola Department Of Surgery,1:MAP Analytics Group,Maywood, IL, USA 4DePaul University,College Of Computing And Digital Media,Chicago, IL, USA
Introduction:
We previously demonstrated implementation of electronic medical record (EMR) systems as a mechanism to overcome the weekend effect (WE) in emergent/urgent surgery. We hypothesized this was related to EMR systems improving OR throughput and care transitions on the weekend. Our objective was to study how individual components of EMR systems contributed to overcoming the WE to test this hypothesis.
Methods:
This was a population-based cohort review using the 2011 Florida HCUP SID database and HIMSS Analytic database. We used prolonged weekend length of stay compared to the weekday at the hospital-level as a surrogate for the WE. Patients who underwent urgent/emergent surgical intervention at hospitals with the WE were propensity matched to patients at hospitals without the WE using patient (demographic, clinical) and hospital (case-mix, structural) characteristics.
Results:
2,841 patients comprised each matched group. EMR in the OR (O.R. 2.52, 95% C.I. [1.77, 3.60]) and electronic medication reconciliation (O.R. 2.43, 95% C.I. [2.10, 2.80]) were associated with overcoming the WE. Computerized physician order entry (O.R. 0.66, 95% C.I. [0.59, 0.75]), electronic bed management systems (O.R. 0.48, 95% C.I. [0.41, 0.55]), and electronic OR scheduling (O.R. 0.51, 95% C.I. [0.35, 0.75]) appeared to be risk factors for the WE. However, specific EMR vendor products within each of those cateogries could protect against the WE (see Table).
Conclusion:
EMR components that influence OR throughput and care transitions impact the ability for hospitals to overcome the WE. Additionally, these results are the first to demonstrate vendor-specific EMR functionality can significantly impact patient care.
