The feasibility of full computerization in the ED

For understanding the feasibility of full computerization of an emergency department (ED), we investigated the completion rate performed by doctors, nurses, or registration clerks since the implementation of full computerization in our ED. We evaluated the changing style of chart-recording, from hand-writing pattern to full computer recording, by recording the execution rate of different information keyed by doctors, nurses, or registration clerks according to their work in ED. We recorded and analyzed different monthly reports of the execution rate in the 18-month period of study. Statistical analysis was performed using Wilcoxon rank-sum test or Kruskal-Wallis one-way ANOVA. The average monthly census was 4570.1 ± 580.7 (95% confidence interval [Cl] for mean: 4281.3, 4858.9). The average execution rate for mode of arrival and triage classification were 97.1 ± 4.1% (95% Cl for mean: 95.1%, 99.1%) and 97.2 ± 4.1% (95% Cl for mean: 95.2%, 99.2%), respectively. In comparison with the execution rate for disposition status between the period of the first 10 months (keying data by nurses) and the late 8 months (keying data by clerks), it showed 72.0 ± 33.2% v 96.7 ± 2.0%; 66.7 ± 35.0% v 95.8 ± 1.9%; 57.5 ± 32.0% v 88.2 ± 8.2% in nontrauma, trauma and pediatric section, respectively, with statistic significance (P < .01). To compare the rate of execution performed by physicians, we divided the study period into 3 phases (phase 1: first 6 months, phase 2: 7-12 months, phase 3: 13-18 months of the study period). The results were statistically significant (P = .004) in phase 3 (83.4 ± 5.3%) with higher execution rate than phase 1 (69.7 ± 7.7%) and phase 2 (75.2 ± 4.9%) in trauma physician. In the pediatric section, it was also significantly higher in phase 3 than phase 2 (88.2 ± 7.7% v 70.7 ± 5.9%, P = .012). We concluded that it is efficient to key in data by registration clerks instead of nurses, and it takes time to persuade and educate most physicians to cooperate in using the computer while seeing patients.