Emergency Department Setting

From Clinfowiki
Jump to: navigation, search

There is a fundamental difference in how Emergency Medicine Physicians practice versus many other specialties. Emergency Medicine Physicians are responsible for the care of a large number of patients, treating their illnesses, and admitting them to the hospital as necessary. The clinical practice of Emergency Medicine requires an extensive field of knowledge. It requires many advanced skills in both adult and pediatric patients that include airway management, surgical procedures, trauma resuscitation, and cardiac life support.

Implementation of CPOE

The generalized implementation of computerized provider order entry (CPOE) has become an important goal of healthcare policy-makers. This is now being accelerated due to the 1999 IOM report "To Err is Human," (Reference) and is further encouraged by reports of benefits in the inpatient and outpatient settings. The physical environment in the Emergency Department presents many challenges for computerized physician order entry (CPOE). The emergency department, with its frantic pace, unpredictability, and variable type of patients, is thought to be a particularly challenging environment in which to introduce CPOE, especially with decision support. Very little has been published regarding efforts in this setting. Therefore, many questions remain about the viability and effectiveness of CPOE in the Emergency Department.

Many studies have shown that CPOE must be highly integrated with a physician’s workflow. Most of these studies to date have shown that entering orders into a CPOE system increases physicians ordering time when compared to writing them on paper. When presented with alerts, reminders, and the presentation of guideline information at the point of care, this will slow the physician to some degree. Given this information, the reluctance of Emergency Medicine Physicians to use CPOE can be understood, especially since many encounters are urgent, with the physician relying on verbal orders during resuscitations or critical care.