Computers in the ER

rninformatics, DNP, RN · May 19, 2005

I hear your frustration and no we (nursing) are not "doomed".

Take a deep breath and put it all in prospective. A 2 hour wait for a sign in screen or for a screen change is unacceptable. Although there is no perfect system, I'm surprised that your nursing and medical staff are tolerating the current one if it is so negatively impacting patient care. There are numerous ER systems on the market but the system (ANY system) is only a tool. Ideally "a tool" that improves patient care and clinical practice. If your organization was having this much trouble with any other "tool", say a faulty piece of diagnostic equipment or a ventilator it would be removed immediately - it would seem the same might be best for the system you wrote about. Just as your team of ER nurses and physicians advocates for the patient related to hands on clinical care so too should you all unit and advocate for changes to resolve your computer system issues. Another proactive move might be for you yourself to volunteer your services to the Information Systems dept as a super user. In this volunteer role you can provide valuable input related to how the system is really working - or not working as you noted in your post. Good Luck!

Please help me with some specific questions. I just discovered this specialty on the forum, never knew you were here! Please don't use too much computer specialty lingo because I won't know what you are talking about.
I am a seasoned nurse and have seen several different computer systems or partial systems. I realize that hospitals are mandated to have computers by 2010, or so we are told, and I want to know if there are any good ER systems. I worked briefly with one called First Net that only had the triage portion implemented, but it seemed to be a user friendly and effective system.
I am now working with one called Amelior, and it is the worst thing I have ever had to deal with in nursing! It has slowed us down immeasurably, caused countless errors, increased wait times tremendously. The average wait time to get from sign in to triage is 2 or more hours at peak times. Then the wait is 2 or more hours (up to 6 the other night)to get to a room. We have a very busy ER, 70,000 patients per year.
Everything takes so much longer. People are frustrated, tired and disgusted. People are constantly being counseled about their attitudes toward it, threatened with their jobs if they don't act like they like it. Nurses are leaving, patients are leaving, and I wonder frequently about being able to give safe care because my time is spent hanging over a computer screen hoping an order will show up and I don't miss it.
This has made me rethink if I want to continue to be a nurse if this is the way it has to be. I am not computer illiterate. I have all the trappings of modern civilization, but this system is killing us. It has seasoned nurses crying, doctors throwing the mouse at the screen, and patients mad and frustrated as we try to pick our way thru the maze of screens and clicks that must be made for things that took meer seconds or minutes before.
Can anyone offer any hope for the future of nursing? I need to think ahead if this is what we must contend with. I can always learn another skill if I need to, but I have 30 years invested in nursing and I need to work another 20! Please tell me we are not doomed!

candyndel · May 19, 2005

We use Ibex in our ED for the past 3 years and have had only a little trouble with it. They update templates as needed and add templates as needed (ie, Universal Protocol).

It doesnt talk to the new in-house charting system, but that hasnt bothered us. All charts are cold fed at midnight to our hospital's automated MR system, which is very nice.

There are finger swipe errors which will come with any drop-down options, but all-in-all Ibex makes life easier. Reports, accessing previous visits, labs, radiology, RXs given, work notes even!

There is a Rapid Triage option and you put the VERY BASICS in. You click on the name and DOB the greeter entered and do a QUICK triage.

Check it out....They are out of Chicago. Many people have come here for site visits as we were the first hosp in the state to go paperless (NJ).

We dont have physician-order-entry...yet. It is only for tracking & MD/RN charting.

Please help me with some specific questions. I just discovered this specialty on the forum, never knew you were here! Please don't use too much computer specialty lingo because I won't know what you are talking about.
I am a seasoned nurse and have seen several different computer systems or partial systems. I realize that hospitals are mandated to have computers by 2010, or so we are told, and I want to know if there are any good ER systems. I worked briefly with one called First Net that only had the triage portion implemented, but it seemed to be a user friendly and effective system.
I am now working with one called Amelior, and it is the worst thing I have ever had to deal with in nursing! It has slowed us down immeasurably, caused countless errors, increased wait times tremendously. The average wait time to get from sign in to triage is 2 or more hours at peak times. Then the wait is 2 or more hours (up to 6 the other night)to get to a room. We have a very busy ER, 70,000 patients per year.
Everything takes so much longer. People are frustrated, tired and disgusted. People are constantly being counseled about their attitudes toward it, threatened with their jobs if they don't act like they like it. Nurses are leaving, patients are leaving, and I wonder frequently about being able to give safe care because my time is spent hanging over a computer screen hoping an order will show up and I don't miss it.
This has made me rethink if I want to continue to be a nurse if this is the way it has to be. I am not computer illiterate. I have all the trappings of modern civilization, but this system is killing us. It has seasoned nurses crying, doctors throwing the mouse at the screen, and patients mad and frustrated as we try to pick our way thru the maze of screens and clicks that must be made for things that took meer seconds or minutes before.
Can anyone offer any hope for the future of nursing? I need to think ahead if this is what we must contend with. I can always learn another skill if I need to, but I have 30 years invested in nursing and I need to work another 20! Please tell me we are not doomed!

Trauma Columnist · May 19, 2005

We use EMSTAT and are very happy with it.

Dixielee, BSN, RN · May 20, 2005

Thanks for the replies. I know there have to be some good systems out there, this is just not one of them. Apparently certain people in the ER administration have committed to this system regardless of what it is doing to the staff and patients. I don't know why. Maybe there is a political angle I am not aware of.

I just found out yesterday that we should expect further problems in the future because the rest of the hospital is going to the Cerner system and there will be some problems interfacing with it. Of course, they keep assuring us that eventually we will all love this system. I still have my doubts.

At this point all we can do is grin and bear it or move on. I see moving on as a viable option for me. It is just getting scarier and scarier and I value my licence too much. I use to love my job and now I dread going in every day. It is not worth the angst, It is just a matter of time before some serious errors are made, and I don't want to be in the middle of it.

RNAnalyst · Jun 19, 2005

I sure hope everything works out for you. I know the frustrations of getting everyone onboard, and when the equipment is not functioining as desired, that can really add to your woes.

Good luck, and hopefully you'll find exactly what you're looking for.

Dixielee, BSN, RN · Jul 13, 2005

I started a new job this week in an ER where they use a wonderfully user friendly computer system called First Net. I think my first experience with a very bad system may have tainted my view of computers in the hospital. We do not use it for all bedside charting, altho that is coming. The triage portion is very nice, and all labs and x ray reports show up and are easy to find and print. We are also using a computerized patient classification that is very easy. I knew there had to be a better way, I am glad I found a place who uses a rational system.