Impact of electronic health record implementation on patient flow metrics in a pediatric emergency department

J Am Med Inform Assoc. May-Jun 2012;19(3):443-7. doi: 10.1136/amiajnl-2011-000462. Epub 2011 Nov 3.


Implementing electronic health records (EHR) in healthcare settings incurs challenges, none more important than maintaining efficiency and safety during rollout. This report quantifies the impact of offloading low-acuity visits to an alternative care site from the emergency department (ED) during EHR implementation. In addition, the report evaluated the effect of EHR implementation on overall patient length of stay (LOS), time to medical provider, and provider productivity during implementation of the EHR. Overall LOS and time to doctor increased during EHR implementation. On average, admitted patients' LOS was 6-20% longer. For discharged patients, LOS was 12-22% longer. Attempts to reduce patient volumes by diverting patients to another clinic were not effective in minimizing delays in care during this EHR implementation. Delays in ED throughput during EHR implementation are real and significant despite additional providers in the ED, and in this setting resolved by 3 months post-implementation.

MeSH terms

  • Appointments and Schedules*
  • Child
  • Efficiency, Organizational*
  • Electronic Health Records*
  • Emergency Service, Hospital / organization & administration*
  • Health Plan Implementation / organization & administration*
  • Hospitals, Pediatric / organization & administration
  • Humans
  • Management Audit*
  • Ohio
  • Organizational Case Studies
  • Outpatient Clinics, Hospital / organization & administration*
  • Quality Indicators, Health Care