Ideal ED length of stay? (information & communications support)

[Howard Berkowitz]

I wonder how much of these issues -- and I include the cardiac patient for cath or ICU, and now the stroke patient for interventional radiology, not just trauma -- can be addressed by a new generation of healthcare information system. One initial start I have seen impemented allows field requests for a particular inpatient bed; the National Emergency Number Association (NENA), I believe, also has defined message formats for doing so. 

Having an information and communications system, of course, means nothing if it is not used. From what I'm hearing here, an ideal process would require both the ED staff, and staff or individuals of the service best qualified to help the patient, to have personal communicators. We've used alphanumeric pagers, typically two-way for this; we have yet to find a wireless LAN system that is completely reliable in safe in hospitals. 

Let me throw out a possible scenario:

1. Advanced EMS with patient, recognizing emergent trauma, cardiac, or brain event. Simultaneously pages medical control (presumably in ED) and the on-call staff for the second service.

2. Second service determines if the patient should go to them, or requests more information. The ED may requet more information. It is TBD if the subsequent information exchange might need to involve a telephone conversation, possibly three way with EMS, ED, and 2nd service.

3. If 2nd service and ED agree, ED sets up for any minimal services need, second service sets up to receive patient, and EMS is informed.

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