New Technology in the ED

Karen Murrell, MD, MBA, FACEP

Vice President, Process ImprovementTEAMHealth

The presenters have nothing to disclose

Contact Info

Karen_Murrell@teamhealth.com

TodayTechnology and artificial intelligence to improve operations

Technology to help with clinical decisions

Telemedicine and new devices

Medical apps for physicians

Emergency Medicine

New Automation Technology

(c) Murrell 2017

Identify problems before they occurPredictive analytics & situational awareness

Decrease cognitive burden on frontlinePrescriptive nudges, real-time priorities & automated actions

Drive engagement and collaborationModern, user-centric design & behavioral science

Operationalize the technologyProject management, data science & change management

IntelligentAutomation

BestPractices

What it takes for technology to successfully improve flow:

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Proactively Preventing ED Crowding

(c) Murrell 2017

14:16

Brent Hubbard (COO) 14:17

What action(s) are we taking to prepare? Is EVS prepared to turn rooms, is phlebotomist available to assist, etc.?

ED11 is awaiting blood draw. We need transport to move ED10 to MS3. 3 admissions awaiting bed assignment.

Bob S (ED Charge Nurse) 14:20

ED Crowding Warning

High ED census expected in 1-2 hours. Please reply with needs.

Chris Turk (Transport) 14:17

We can send transport in 5 min.

Automating ED Patient Movement

(c) Murrell 2017

Delayed Labs / Radiology

Engages ancillaries to facilitate flow

Key Results Back

Prompts physician to finalize disposition as

studies completed

Accelerate Discharge

Mobilizes team to remove potential discharge barriers

14:16

Florence Nightingale (ED Charge Nurse) 14:17CT order outstanding for

diagnosis. Radiology, can you help?

We can be ready for patient in 20 min. Transport, can you send patient over?

Elliot Reed (Radiology) 14:20

Radiology Delay Warning

ED12 has pending CT order that has not been started. Please consider expediting.

14:16

John Durian (ED Physician) 14:17Currently with patient in ED18. Will review results and determine if additional treatment is needed

Thank you Dr. Durian.

Florence Nightingale (ED Charge Nurse) 14:20

Key Results Back

Dr. Durian, your patient in ED13 has 1/1 rads resulted and 3/3 labs returned. Is dispopossible?

14:16

Florence Nightingale (ED Charge Nurse) 14:17Patient needs

transportation. Case management, can you help arrange?

Calling family to arrange pickup

Emma Smith (Case Management) 14:20

Accelerate Discharge

ED23 who came by EMS might need a ride arranged. Please prioritize and respond if you need support.

John Durian (ED Physician) 14:29

Results reviewed. Patient can be discharged, placing d/c order now

For LeadershipRetrospective data– Can pull real time reports yourself– Identify drivers for unexpected problems (eg long length of stay-

patient acuity, slower than average MD, lab, radiology, etc)Real time– “Pushes” to caregivers– Accountability for surge plans– Fall prevention– Patient care experience

Prospective– Predicting high volume states and give recommendations– Staffing to predicted demand

(c) Murrell 2015

Physician Workload

(c) Murrell 2015

Clinical systems that remove the barrier between the MD and the patientReplaces ESI levels with AI driven information for segmentation and predicts patient workloadPatients assigned to a provider on arrivalPhysicians can design their shifts (eg- more patients at beginning, simpler patients at the end)Allows charge nurse to focus on the back end flow

Patient Assignment

(c) Murrell 2015

Behind the scene each MD can have customized requests

Clinical Decisions

(c) Murrell 2015

Evidence Based Decisions

Pediatric Head Injury

Pulmonary Embolism

Chest Pain

Pediatric abdominal pain

Critical it is easy to use and not an extra step!

Allows families to participate in decision making…

Massachusetts General

• Published in ACEP Now• Ali Raja, MD, MBA

developed tools to improve adherence for ED imaging

• Improved both imaging use and adherence to guidelines

Work in Progress

Many isolated studies and applications starting

Most physician led because of risk perception

Much more work to be done

Telemedicine

Telemedicine

Data still out on ED utilization affect

Very helpful for rural areas with poor access

Tele -psychiatry a growing field

In ED- specialty care: stroke, ICU, pediatrics

Telemedicine Reimbursement

26 states have “parity” laws that require private insurers to reimburse for tele-health

Medicare: must live in “Health Professional Shortage area”

Medicaid: varies state by state

Kaiser Permanente Mid AtlanticVideo visit at home for no patient costVideo visit at the CDU’s with a nurse/tech to help with physical examAllows workload at the sites to be more evenly distributed without travel for physiciansCoordination allows for good patient followup

Medical Apps: EMRA PressorDex

• $16.99

• Guide to medications and dosing needed for critically ill patients

• Easy to use and comprehensive

Medical Apps: ERres• $9.99

• Medications lists

• Algorithms

• Decision rules

• Toxicology

• Procedures

• Intubation tools

Medical Apps: Eye Emergency Manual

• Free

• Developed in England

• Has a clinical decision tree that can be helpful

MDCalc• Free

• Provides calculators for clinical decisions

• Next steps after calculation are given

• Evidence based information

Not So Obvious Medical AppsGout Diagnosis: Joshua Steinberg– Free– Calculates probability of symptoms being gout

Good RX– Free– Helps show patients cost of medication and gives coupons

OrthoFlow– $4.99– Provides care guidelines and guidance when evaluating

fractures

Not So Obvious Medical AppsSTD TxGuide from the CDC– Free– Helpful especially for Pen allergic patients and unusual

conditionsACEP Toxicology – Free– Provides dosing guidelines– Put in overdose and it directs you to the antidote

The Ottowa Rules– Free– Easy to walk through photos and clinical decision tools– Could be patient facing to help with decisions

Not So Obvious Medical AppsMaking Healthy Choices– Free– From Consumer Reports– Can help with discussions on why a certain test is not indicated

(x-ray for back pain)

iMedicalApps.com is a great resource for new Apps

Questions and Discussion