Validating emergency department vital signs using a data quality engine for data warehouse.

BACKGROUND: Vital signs in our emergency department information system were entered into free-text fields for heart rate, respiratory rate, blood pressure, temperature and oxygen saturation. OBJECTIVE: We sought to convert these text entries into a more useful form, for research and QA purposes, upon entry into a data warehouse. METHODS: We derived a series of rules and assigned quality scores to the transformed values, conforming to physiologic parameters for vital signs across the age range and spectrum of illness seen in the emergency department. RESULTS: Validating these entries revealed that 98% of free-text data had perfect quality scores, conforming to established vital sign parameters. Average vital signs varied as expected by age. Degradations in quality scores were most commonly attributed logging temperature in Fahrenheit instead of Celsius; vital signs with this error could still be transformed for use. Errors occurred more frequently during periods of high triage, though error rates did not correlate with triage volume. CONCLUSIONS: In developing a method for importing free-text vital sign data from our emergency department information system, we now have a data warehouse with a broad array of quality-checked vital signs, permitting analysis and correlation with demographics and outcomes.

A pilot study on usability analysis of emergency department information system by nurses.

OBJECTIVES: Employing new health information technologies while concurrently providing quality patient care and reducing risk is a major challenge in all health care sectors. In this study, we investigated the usability gaps in the Emergency Department Information System (EDIS) as ten nurses differentiated by two experience levels, namely six expert nurses and four novice nurses, completed two lists of nine scenario-based tasks. METHODS: Standard usability tests using video analysis, including four sets of performance measures, a task completion survey, the system usability scale (SUS), and sub-task analysis were conducted in order to analyze usability gaps between the two nurse groups. RESULTS: A varying degree of usability gaps were observed between the expert and novice nurse groups, as novice nurses completed the tasks both less efficiently, and expressed less satisfaction with the EDIS. The most interesting finding in this study was the result of 'percent task success rate,' the clearest performance measure, with no substantial difference observed between the two nurse groups. Geometric mean values between expert and novice nurse groups for this measure were 60% vs. 62% in scenario 1 and 66% vs. 55% in scenario 2 respectively, while there were some marginal to substantial gaps observed in other performance measures. In addition to performance measures and the SUS, sub-task analysis highlighted navigation pattern differences between users, regardless of experience level. CONCLUSION: This study will serve as a baseline study for a future comparative usability evaluation of EDIS in other institutions with similar clinical settings.

EMCyberSchool: an evaluation of computer-assisted instruction on the Internet.

OBJECTIVES: To test the hypothesis that integration of the EMCyberSchool, a computer-assisted instruction (CAI) tool available on the Internet, into the curriculum of a senior medical student subinternship in emergency medicine (EM) would improve exam scores and course satisfaction. METHODS: Students were prospectively randomized, by four-week blocks, into a CAI group and a no-CAI group. All students were surveyed on previous computer experience and their use and opinion of the EMCyberSchool. RESULTS: Completed data were obtained from 100 of 120 students. Sixty-five percent of the students said they wanted CAI as an adjunct to their course curricula; only 28% actually used the educational tool. The students who used the site rated it useful (4.2/5), easy to use (4.4/5), and easy to access (4.1/5). Of the students who had access, and chose not to use the EMCyberSchool, 77.8% reported not having enough time as the reason for not using the site. The mean exam scores were 72.8% for the students in the CAI group and 68.2% for those in the no-CAI group (p = 0.058). In the CAI group, 77.5% (31/40) of the students rated the course as outstanding or excellent; compared with 66% (33/50) in the no-CAI group (p = 0.23). CONCLUSIONS: Although desired, it remains unclear whether CAI on the Internet is a useful adjunct for teaching EM to medical students.

Emergency medicine at the Mount Sinai School of Medicine.

Emergency medicine became the twenty-third specialty by the American Board of Medical Examiners in 1979. Emergency physicians are specialists in the stabilization and resuscitation of medical and surgical emergencies in patients of all ages; they are experts in triage and in prioritization of resources. Emergency physicians provide the "safety net" for the American health care system, and they are the facilitators between the community and health care systems, and between primary care physicians and specialists. The emergency department is an ideal environment in which to teach the assessment and management of patients presenting with undifferentiated processes. Emergency physicians possess a unique set of clinical and research skills that have made them valuable members of the medical school academic community. Presented is a historical perspective on the specialty of emergency medicine and its evolving role at the Mount Sinai School of Medicine. Included are discussions on innovations in teaching developed by the emergency medicine faculty, including applications of computer-assisted instruction and the Internet.

Stroke syndromes.

Emergency physicians must stay cognizant of the rapid and dramatic changes underway in the management of patients with acute stroke syndrome. The future clearly points towards a time when emergency physicians will be called upon to treat "brain attacks" in a manner similar to heart attacks, with early recognition and treatment. As effective interventions are developed, we will be able to alter the course, increase the survival, and decrease the morbidity and long-term disability of stroke patients.