Emergency Department of the New Era

Abstract

The past 10 years have demonstrated a dramatic evolution in how patients are cared for overall. The emergency department (ED) is where technologic solution has the potential to be most helpful because of the unpredictable, time-sensitive nature of patient logistics. In this chapter we review the evolution of these approaches as they relate to the problems they address. The availability of patient data may be the single greatest challenge and opportunity in the ED setting. The transition to electronic medical records and then electronic health records and the promise of networked health information exchanges are reviewed. Patient flow is a problem that vexes nearly every ED. How to pair the right resources and the right patient in a prompt, cost-effective manner is a challenge which in the modern ED can be assuaged by a variety of approaches. The most common include the application of queuing theory, and lean methodology, in addition to simpler approaches such as adjustments to the triage liaison provider and separation of low-acuity patients. Clinical documentation is a problem in nearly every healthcare setting, but the ED highlights this workflow bottleneck. The use of medical scribes, speech recognition software, and wearable computing devices has all shown promise, but each comes with their distinct advantages and disadvantages. Finally, clinical decision support, crowd-sourced open-access medical information, the ED application of telemedicine, prehospital testing, and point-of-care testing are discussed. This chapter provides an overview of how the challenges of a modern ED are met with modern solutions and provides the evidence supporting these changes.