A Web-Based System for Monitoring Patient Flow in an Emergency Department

To the Editor: We describe a simple-to-implement Web-based system that replaces the traditional dry-erase whiteboard for logging and tracking patient information in a psychiatry emergency consultation service. Patient information can be displayed for the treatment team and simultaneously shared with authorized users across a hospital's intranet.

St. Joseph's Health Centre is a large community hospital in Toronto with four inpatient psychiatric units and a busy emergency psychiatry team (EPT) based in the emergency department. Efforts to improve the flow of admitted patients from the emergency department to the inpatient units revealed a critical bottleneck in communication. To manage workflow, the EPT used a traditional dry-erase whiteboard, entering detailed information about patients referred, currently being assessed, and admitted and their order in the queue for beds.

Emergency department nursing staff and nurses on the inpatient units could obtain this information only by telephone contact with EPT clinicians. This method was unreliable because members of the EPT are often out of the office interviewing patients. The communication problems often resulted in significant delays in transfer to the inpatient units, and some patients were transferred out of the priority sequence.

Our solution was to create a Web-based version of the same system (http://dl.dropbox.com/u/49189/e-whiteboard/index.html) on the hospital's intranet. EPT clinicians enter information at their workstations. The page is displayed on a large TV monitor that replaces the old whiteboard. Dedicated monitors have been placed in the emergency department, psychiatry inpatient nursing stations, and managers' offices. No monitor is visible to patients or visitors. The page can also be seen on any computer in the hospital as long as the user has been granted access permission by the medical director or EPT manager.

The EPT medical director designed the Web-based system and conducted implementation and training. EPY members use a freeware HTML editing program (Kompozer), which operates like a word processer.

Per-patient waiting time for an inpatient bed has been reduced by 38% since introduction of the new system in July 2009, which permits the EPT manager to monitor the emergency department situation in real time and to immediately detect and address delays in transfer to inpatient beds. Inpatient nurses now know as soon as a patient is admitted—sometimes well before the admission orders are processed. Phone calls to the EPT for information displayed on the board have stopped. Conflicts between emergency department staff and inpatient staff resulting from failure to convey information have been eliminated.

The EPT clinicians find the system easy to use and much prefer it over the dry-erase whiteboard, which required them to frequently rewrite patient information as patients were discharged and the order in the queue changed.

A snapshot of the Web page is saved every 15 minutes, allowing us to collect statistics about team performance, patient flow, and length of stay in the emergency department in relation to volume of patients being served.

Computer technology is now both sufficiently advanced and user friendly that simple applications can create dramatic improvements in efficiency. Any organization with an intranet can apply this model to information sharing, without the expense of consultants and maintenance contracts.