Prior EHR information upon ED presentation was associated with lower odds of mortality if hospitalized (OR 0.55; 95% CI 0.38-0.81) and fewer tests and medications in two of three EDs.
Cohort (n=5,166)
Yes
Does the availability of prior information in the electronic health record improve care outcomes and efficiency in adults with heart failure presenting to the emergency department?
The availability of prior electronic health record information for heart failure patients in the ED is associated with reduced mortality and resource utilization in some settings, though effects vary by institution.
Odds Ratio: 0.55 (95% CI 0.38–0.81)
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. CONCLUSIONS: An EHR may have the potential to be a valuable adjunct in the care of heart failure patients.
Connelly et al. (Thu,) conducted a cohort in heart failure (n=5,166). Prior information in the electronic health record (EHR) upon ED presentation vs. No prior information in the EHR (external) was evaluated on Mortality if hospitalized (OR 0.55, 95% CI 0.38 to 0.81). Prior EHR information upon ED presentation was associated with lower odds of mortality if hospitalized (OR 0.55; 95% CI 0.38-0.81) and fewer tests and medications in two of three EDs.