Baseline Assessment, Intervention, and Interval Reassessment of Clinical Information Systems Infrastructure in an Academic Regional Referral Emergency Department

The widespread use of clinical information systems (CIS) creates ample opportunities for CIS-associated operational disruptions and delays that can negatively impact patient care. A clinical quality improvement (QI) project studied the CIS infrastructure at an academic regional referral emergency department (ED) at baseline and after implementation of targeted sustainment interventions. An ED 5S workgroup collaborated with ED clinical leaders and institutional information services (I.S.) teams to conduct comprehensive CIS inventory and function testing in 2016; an end-user survey on CIS functionality and impact were administered. Findings were analyzed to determine common points of failure, and concerted interventions were implemented during 2016-2018: development of a structured ED CIS inventory document with device mapping and specification of clinical functions; prioritized repair/replacement of non-functional/missing devices; institution of scheduled ED "Tech Rounds"; and installation of a self-service work-ticket Web portal for repair requests. A follow-up reassessment and survey in 2018 revealed mixed intervention results and highlighted infrastructure elements superseded by advances in mobile technology. Overall, a multi-disciplinary effort assessed an ED CIS infrastructure and its functionality at baseline and over time for changes associated with targeted interventions. Studied metrics revealed some successes and ongoing challenges.