Recording and Reporting Wait Times in the Emergency Department

1. Recording and Reporting Wait Times in the Emergency Department 1Sara B. Dawson, 1Brian Decker, 1Samira Madhany, 2Doris Quinn, PhD, 3Jane Crofut, RN, 3Tim LeMay, 3Jim Bihun 1Department of Biomedical Engineering, 2Department of Quality Education and Measurement, 3Department of Emergency Medicine Vanderbilt University http://mot.vuse.vanderbilt.edu/274/bears/timecharter.htm

2. Background The processes in the emergency department have been accepted as random and unpredictable. For that reason, there has been little effort put forth to determine any underlying factors that influence the time a patient spends in the ED during the many steps encountered in the process. Dr. Doris Quinn hypothesizes that if adequate data is collected over time, comprehensive reports might show trends that affect the processes of patient flow.

3. Objectives • Provide the Emergency Department (ED) with a method of storing and utilizing patient visit data • Provide a method of reporting wait times based upon varying factors of the ED processes • Demonstrate the capabilities of using a dynamically driven database interface in a hospital environment

4. Tasks • We determined the needs and wishes of the ED. • We created a flow chart of patient flow process and defined wait times. • We developed a MS Excel spreadsheet that automatically calculated patient wait times. • We created charts using results of the MS Excel spreadsheet.

5. Tasks • We used Allaire’s Cold Fusion 4.0 to create another application to collect and store data and produce reports and charts. • We designed the database in MS Access ‘97. • We used HTML and CFML (Cold Fusion Markup Language) to create an interface to the database accessed with any web browser.

6. 1 2 3 4 5 6 7 Wait Times for VUMC ED Wait Times 1. Triage Wait 2. Room Wait 3. Resident Wait 4. Attending Wait 5. Interface Wait 6. Treatment Wait 7. Disposition Wait

7. Calculates wait times after data is abstracted from patient charts Creates charts of length of stay versus arrival time Creates a multi-bar chart of all wait times versus arrival time Charts are automatically generated upon entry of ED process times Limited access to patient information Accessed with any standard web browser Secured login Administration editing Patient information Patient time entry Statistical reports by: date time wait segment complete report Application Features MS Excel Spreadsheet Features Cold Fusion ED Time Charter Features

8. MS Excel Charts

9. Cold Fusion ED Time Charter Entry form Wait Time Chart

10. Results • We created two effective applications that will aid the VUMC ED and Department of Quality Education and Measurement to provide information about the patient flow processes. • The MS Excel spreadsheet will be used as a template to replace the one currently used by data entry operators.

11. Results • The Cold Fusion application provides an alternative example of how explosive, cutting-edge web technology may be utilized to provide simple entry forms and comprehensive reports capable of being accessed by all given privilege with any web browser.

12. Futures • Present both applications to ED Administration - April 9th • Continue coordination with Dr. James Crowe in an effort to obtain CF Server space behind hospital secured firewall • Continue to explore advanced reporting capabilities with Cold Fusion