The following is an editorial. The views, opinions and positions expressed by contributing authors and those providing editorials and comments on this blog are theirs alone, and do not necessarily reflect the views, opinions or positions of Arizona Emergency Medical Systems, Inc.
The EPCR (Electronic Patient Care Record) has been touted as the greatest advent in patient care since the invention of the disposable emesis bag. Complete charts, accurate times, pertinent data entry were what the EPCR promised. And the EPCR delivers just that. What wasn’t promised and isn’t being delivered is a documented record of prehospital events to the receiving emergency department at the time of the patient’s transfer. It isn’t unusual for EDs to have to wait days/weeks to obtain a printed record.
As we strive to improve the modalities of care, the prehospital events become more and more important. Strokes and STEMIs are only a few of the medical conditions where the prehospital incident report contains vital information. Yet, these reports are becoming less and less available at the time of transfer/off-load.
Recently, a question arose regarding the time a narcotic was administered to a patient. The involved agency uses an EPCR system, hence there was no documentation left for the ED staff to consult. Since it had only been 30 minutes since the patient had been off-loaded, the EPCR was not available to the physician caring for the patient. A call to the EMS agency’s requesting that the incident report be sent. The response was: “Well, I gave report to the nurse”.
What does the future bring to the care of the patient whose EMS agency uses EPCR? Without the ability of EMS to provide a hard copy of the prehospital incident report (run sheet) when the patient is turned over to the hospital, the oral report becomes more vital. Should emergency departments record the oral report for reference? Should that oral report contain all the information that is needed to provide care and treatment for the patient? Has the EPCR not only increased the length of time it takes to appropriately care for a patient but also increased turnaround times for EMS?
Understandably for billing/data collection, the EPCR is a wonderful tool. It provides those involved with the ability to capture information in a legible print. But any tool, if poorly designed, despite all the bells and whistles is essentially useless if it doesn’t address its basic function- to assist in providing care for the patient.
As an ED nurse who has taken report on hundreds if not thousands of patients from EMS, I frequently only required a quick oral report because I knew that the EMS crew would provide me with a run sheet before they left the facility. That run sheet provided the information needed to take care of the patient. With the current application of the EPCR, have we taken a step forward and 2 steps backward?
Respectfully submitted by
G. Gabriel RN CEN