Patients treated for heart failure in the emergency department fare better if there is an electronic health record available
Research Activities, November 2012, No. 387
When patients with heart failure are brought to an emergency department (ED) at a hospital that has electronic health records (EHRs), those with prior data in the EHR are less likely to die during hospitalization than similar patients without such data, concludes a new study. Typically, a sudden emergency such as heart failure causes a transition in care from the community to the hospital ED without a chance for a patient to bring medical records. However, if the patient is taken to a hospital where they have been treated before, the ED providers can access the patient's EHR.
The researchers analyzed records for 5,166 patients with heart failure brought to three hospital EDs. They found that, at two EDs, patients with prior electronic records ("internals") were 45 percent and 55 percent less likely, respectively, to die during hospitalization than those without prior records ("externals"). For these EDs, internal patients were also found to have 4.6 percent and 14 percent fewer laboratory tests performed in the ED, respectively, and received 33.6 percent and 21.3 percent fewer medications, respectively, than the external patients. Internal patients at one of these two EDs also had 63 percent lower chance of hospitalization. The researchers found, however, that internal patients at the third ED differed from external patients only in experiencing a 32.3 percent increase in their length of stay in the ED. The mixed results across the three settings may have been the product of differences in the EHR services deployed, the length of their deployment, and many other local contextual issues.
The findings were based on a retrospective, observational study of all patients 18 years or older seen for heart failure at three selected EDs, each associated with a different health system but in the same geographic area. The study was funded in part by the Agency for Healthcare Research and Quality (HS16155).
More details are in "The impact of electronic health records on care of heart failure patients in the emergency room," by Donald P. Connelly, M.D., PhD, Young-Taek Park, Jing Du, and others in the May 2012 Journal of the American Medical Informatics Association 19(3), pp. 334-340.