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Electronic OR Scheduling Linked to 33% Reduction in 'Weekend Effect'

News  |  By Alexandra Wilson Pecci  
   May 02, 2017

The outcomes of patients who undergo non-elective surgery on weekends improve when hospitals use electronic operating room scheduling systems and bed-management systems.

Electronic medical record systems significantly improve outcomes for patients who undergo surgeries on weekends, asserts a Loyola Medicine research letter published in JAMA Surgery.

The so-called "weekend effect" of longer hospital stays, higher mortality rates, and ramped-up readmissions has been documented by this Loyola research team in the past.

It noted in a 2015 study that EHR/EMR adoption was the biggest single factor in reducing the weekend effect.

The new study set out drill down even further, by identifying which components of EHR/EMR systems can help overcome the effect.

Chief among them are electronic systems designed to seamlessly schedule surgeries and move patients into and out of hospital rooms. Research showed that patients at hospitals with electronic operating room scheduling were 33% less likely to experience the weekend effect than patients at hospitals with paper-based scheduling.

Patients were 35% less likely to experience the weekend effect at hospitals with electronic bed-management systems.

"Together, these data illustrate an important relationship that may exist between [EHR/EMR] systems and temporal care disparities in non-elective surgical settings," the authors write.

The researchers retrospectively examined patient data from the Agency of Healthcare Research and Quality-sponsored Healthcare Cost and Utilization Project State Inpatient Database.

The study included 2,979 patients who were admitted during weekends to Florida hospitals in 2011 for three types of urgent surgeries:

  • Appendectomy,
  • Acute hernia repair
  • Cholecystectomy (gallbladder removal)

Florida was selected because of its large, diverse population, the researchers said.

Of the 2,979 weekend surgery patients, 946 (32%) experienced the weekend effect, defined as having longer hospital stays than normally would be expected. Patients who did not experience the weekend effect were more likely to be at hospitals with:

  • High-speed EHR/EMR connectivity
  • EHR/EMR access in the operating room
  • Electronic operating room scheduling
  • Computerized physician ordering systems
  • Electronic bed management systems

The new research was conducted by Loyola's predictive analytics program, which mines big data to predict health outcomes, the university said.

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In addition to full EHR/EMR adoption, the 2015 study also identified four other factors that help combat the weekend effect:

  • Home health programs
  • Pain management programs
  • Increased registered nurse-to-bed ratios
  • Inpatient physical rehabilitation

"We're now able to ask and answer a broad range of questions that could significantly help improve patient care and reduce costs," corresponding author Paul Kuo, MD, MS, MBA, said in a statement.

Kuo is chair of Loyola's department of surgery and head of Loyola's analytics group, One to Map Analytics. 

Alexandra Wilson Pecci is an editor for HealthLeaders.

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