The Role of Integrated Health Informatics in Streamlining Patient Flow from Emergency Department to Admission: A Review of Administrative and Clinical Synergies

Majed Salah Almarwani (1), Salha Ahmed Mohammed Osis (2), Ghosoon Ahmad Mohd Osis (3), Fatimah Mohammed (4), Khaled Mohammed Alharbi (5), Abdulaziz Ali Abdulaziz Aldobayan (6), Mohammed Fahad Mohammed Hawbani (6), Ramzi Hassan Ahmed Julayhi (6), Samir Ahmed Hassan Alwadani (6), Abdulrahman Ahmed Mohammed Maslmani (6), Hayfaa Mohammed Saad Shuraidh (7), Bashayr Radhi Alwan Aldhafeeri (8)
(1) Uhud Hospital, Ministry of Health, Saudi Arabia,
(2) Al-Ahad Primary Care Center, Ministry, Saudi Arabia,
(3) Al Ahad General Hospital, Ministry of Health, Saudi Arabia,
(4) Medical Secretary, Ministry of Health, Saudi Arabia,
(5) Hafar Al-Batin – Emergency and Crisis Management, Ministry of Health, Saudi Arabia,
(6) Al Arda General Hospital, Ministry of Health, Saudi Arabia,
(7) Ministry of Health, Saudi Arabia,
(8) Maternity and Children Hospital, Ministry of Health, Saudi Arabia

Abstract

Background: Emergency Department (ED) overcrowding and hospital-wide patient flow blockages represent a critical challenge for healthcare systems globally, impacting patient safety, staff well-being, and organizational efficiency. The journey from ED triage to inpatient admission is a complex, multi-stakeholder process prone to delays and communication failures. Aim: This narrative review synthesizes contemporary literature (2010-2024) to examine how integrated health informatics—spanning Electronic Health Records (EHRs), patient tracking systems, and interoperable platforms—facilitates administrative and clinical synergies to streamline patient flow from the ED to admission. Methods: A systematic search was conducted across PubMed, CINAHL, Scopus, and ProQuest databases, identifying peer-reviewed articles, systematic reviews, and seminal reports. Results: Findings reveal that interoperable health informatics enhances real-time visibility, improves interprofessional communication, and supports data-driven decision-making. Successful implementation is shown to reduce ED length of stay (LOS), left-without-being-seen (LWBS) rates, and ambulance diversion. Crucially, it transforms roles, particularly for nursing and unit secretaries, shifting them towards proactive flow coordination. However, significant barriers persist, including interoperability limitations, workflow misalignment, and training deficits. Conclusion: Integrated health informatics is indispensable for modern patient flow management, creating synergistic "command centers" that bridge clinical and administrative functions. Future success hinges on human-centered design, robust change management, and viewing informatics not as a mere tool but as the foundational architecture for a resilient, patient-centered healthcare system. 


 

Full text article

Generated from XML file

References

Abbassi, A., Hasni, N., & Hamida, E. B. (2022, November). Impact of computerized physician order entry system on parenteral nutrition medication errors in a teaching neonatal intensive care unit. In Annales pharmaceutiques francaises (Vol. 80, No. 6, pp. 819-826). Elsevier Masson. https://doi.org/10.1016/j.pharma.2022.05.002

Ash, J. S., Sittig, D. F., Dykstra, R., Campbell, E., & Guappone, K. (2009). The unintended consequences of computerized provider order entry: findings from a mixed methods exploration. International journal of medical informatics, 78, S69-S76. https://doi.org/10.1016/j.ijmedinf.2008.07.015

Ben-Tovim, D. I. (2017). Process redesign for health care using lean thinking: a guide for improving patient flow and the quality and safety of care. CRC Press.

Benson, T., & Grieve, G. (2021). Principles of health interoperability. Springer International Publishing.

Booker, C., Turbutt, A., & Fox, R. (2016). Model of care for a changing healthcare system: are there foundational pillars for design?. Australian Health Review, 40(2), 136-140. https://doi.org/10.1071/AH14173

Boyle, A., Abel, G., Raut, P., Austin, R., Dhakshinamoorthy, V., Ayyamuthu, R., ... & Burton, J. (2016). Comparison of the International Crowding Measure in Emergency Departments (ICMED) and the National Emergency Department Overcrowding Score (NEDOCS) to measure emergency department crowding: pilot study. Emergency Medicine Journal, 33(5), 307-312. https://doi.org/10.1136/emermed-2014-203616

Carter, E. J., Pouch, S. M., & Larson, E. L. (2014). The relationship between emergency department crowding and patient outcomes: a systematic review. Journal of Nursing Scholarship, 46(2), 106-115. https://doi.org/10.1111/jnu.12055

Collins, S. A., Bakken, S., Vawdrey, D. K., Coiera, E., & Currie, L. M. (2011). Agreement between common goals discussed and documented in the ICU. Journal of the American Medical Informatics Association, 18(1), 45-50. https://doi.org/10.1136/jamia.2010.006437

Di Somma, S., Paladino, L., Vaughan, L., Lalle, I., Magrini, L., & Magnanti, M. (2015). Overcrowding in emergency department: an international issue. Internal and emergency medicine, 10(2), 171-175. https://doi.org/10.1007/s11739-014-1154-8

Forstater, A., Sicks, S., Collins, L., & Schmidt, E. (2019). Team SAFE: a large-scale interprofessional simulation-based TeamSTEPPS® curriculum. Journal of Interprofessional Education & Practice, 16, 100221. https://doi.org/10.1016/j.xjep.2018.12.002

Graber, M. L., Byrne, C., & Johnston, D. (2017). The impact of electronic health records on diagnosis. Diagnosis, 4(4), 211-223. https://doi.org/10.1515/dx-2017-0012

Gross, T. K., Lane, N. E., & Timm, N. L. (2023). Crowding in the emergency department: challenges and best practices for the care of children. Pediatrics, 151(3), e2022060972. https://doi.org/10.1542/peds.2022-060972

Holden, R. J., & Karsh, B. T. (2010). The technology acceptance model: its past and its future in health care. Journal of biomedical informatics, 43(1), 159-172. https://doi.org/10.1016/j.jbi.2009.07.002

Kansagara, D., Englander, H., Salanitro, A., Kagen, D., Theobald, C., Freeman, M., & Kripalani, S. (2011). Risk prediction models for hospital readmission: a systematic review. Jama, 306(15), 1688-1698. doi:10.1001/jama.2011.1515

Kelen, G. D., Sauer, L., Clattenburg, E., Lewis-Newby, M., & Fackler, J. (2015). Pediatric disposition classification (reverse triage) system to create surge capacity. Disaster Medicine and Public Health Preparedness, 9(3), 283-290. doi:10.1017/dmp.2015.27

Khanna, S., Sier, D., Boyle, J., & Zeitz, K. (2016). Discharge timeliness and its impact on hospital crowding and emergency department flow performance. Emergency Medicine Australasia, 28(2), 164-170. https://doi.org/10.1111/1742-6723.12543

Moore, E. C., Tolley, C. L., Bates, D. W., & Slight, S. P. (2020). A systematic review of the impact of health information technology on nurses’ time. Journal of the American Medical Informatics Association, 27(5), 798-807. https://doi.org/10.1093/jamia/ocz231

Morais Oliveira, M., Marti, C., Ramlawi, M., Sarasin, F. P., Grosgurin, O., Poletti, P. A., ... & Rutschmann, O. T. (2018). Impact of a patient-flow physician coordinator on waiting times and length of stay in an emergency department: A before-after cohort study. Plos one, 13(12), e0209035. https://doi.org/10.1371/journal.pone.0209035

Morley, C., Unwin, M., Peterson, G. M., Stankovich, J., & Kinsman, L. (2018). Emergency department crowding: a systematic review of causes, consequences and solutions. PloS one, 13(8), e0203316. https://doi.org/10.1371/journal.pone.0203316

Musty, B. (2023). Analyzing the changing role of professional secretary in dealing with the impact of digital technology (A case study on professional secretaries in Indonesia). International Journal of Business, Economics, and Social Development, 4(1), 12-19. https://doi.org/10.46336/ijbesd.v4i1.380

Nguyen, Q., Wybrow, M., Burstein, F., Taylor, D., & Enticott, J. (2022). Understanding the impacts of health information systems on patient flow management: A systematic review across several decades of research. PloS one, 17(9), e0274493. https://doi.org/10.1371/journal.pone.0274493

Phattharapornjaroen, P., Carlström, E., & Khorram-Manesh, A. (2022). Developing a conceptual framework for flexible surge capacity based on complexity and collaborative theoretical frameworks. Public Health, 208, 46-51. https://doi.org/10.1016/j.puhe.2022.04.012

Pines, J. M., Hilton, J. A., Weber, E. J., Alkemade, A. J., Al Shabanah, H., Anderson, P. D., ... & Schull, M. J. (2011). International perspectives on emergency department crowding. Academic Emergency Medicine, 18(12), 1358-1370. https://doi.org/10.1111/j.1553-2712.2011.01235.x

Rathlev, N. K., Visintainer, P., Schmidt, J., Hettler, J., Albert, V., & Li, H. (2020). Patient characteristics and clinical process predictors of patients leaving without being seen from the emergency department. Western Journal of Emergency Medicine, 21(5), 1218. https://doi.org/10.5811/westjem.2020.6.47084

Reznek, M. A., Murray, E., Youngren, M. N., Durham, N. T., & Michael, S. S. (2017). Door-to-imaging time for acute stroke patients is adversely affected by emergency department crowding. Stroke, 48(1), 49-54. https://doi.org/10.1161/STROKEAHA.116.015131

Shapiro, J. S., Johnson, S. A., Angiollilo, J., Fleischman, W., Onyile, A., & Kuperman, G. (2013). Health information exchange improves identification of frequent emergency department users. Health Affairs, 32(12), 2193-2198. https://doi.org/10.1377/hlthaff.2013.0167

Shenvi, E., Boxwala, A., Sittig, D., Zott, C., Lomotan, E., Swiger, J., & Dullabh, P. (2023). Visualization of patient-generated health data: a scoping review of dashboard designs. Applied Clinical Informatics, 14(05), 913-922. DOI: 10.1055/a-2174-7820

Singer, A. J., Thode Jr, H. C., Viccellio, P., & Pines, J. M. (2011). The association between length of emergency department boarding and mortality. Academic Emergency Medicine, 18(12), 1324-1329. https://doi.org/10.1111/j.1553-2712.2011.01236.x

Sun, Y., Teow, K. L., Heng, B. H., Ooi, C. K., & Tay, S. Y. (2012). Real-time prediction of waiting time in the emergency department, using quantile regression. Annals of emergency medicine, 60(3), 299-308. https://doi.org/10.1016/j.annemergmed.2012.03.011

Tsai, W. C., Liu, C. F., Lin, H. J., Hsu, C. C., Ma, Y. S., Chen, C. J., ... & Chen, C. C. (2022, August). Design and implementation of a comprehensive AI dashboard for real-time prediction of adverse prognosis of ED patients. In Healthcare (Vol. 10, No. 8, p. 1498). MDPI. https://doi.org/10.3390/healthcare10081498

Vest, J. R., & Gamm, L. D. (2010). Health information exchange: persistent challenges and new strategies. Journal of the American Medical Informatics Association: JAMIA, 17(3), 288. https://doi.org/10.1136/jamia.2010.003673

Wisner, K., Lyndon, A., & Chesla, C. A. (2019). The electronic health record’s impact on nurses’ cognitive work: An integrative review. International Journal of Nursing Studies, 94, 74-84. https://doi.org/10.1016/j.ijnurstu.2019.03.003

Wong, G., Greenhalgh, T., Westhorp, G., Buckingham, J., & Pawson, R. (2013). RAMESES publication standards: realist syntheses. BMC medicine, 11(1), 21. https://doi.org/10.1186/1741-7015-11-21

Zafar, Z., Ashraf, N., Alamgir, W., Rehman, A., & Ilyas, S. (2023). Comparison of the International Crowding Measure in Emergency Departments (ICMED) and the National Emergency Department Overcrowding Study (NEDOCS) in Tertiary Care Hospital to Measure Emergency Department Crowding. Pakistan Armed Forces Medical Journal, 73(1). DOI: 10.51253/pafmj.v73i1.8202

Authors

Majed Salah Almarwani
Msalmarwani@moh.gov.sa (Primary Contact)
Salha Ahmed Mohammed Osis
Ghosoon Ahmad Mohd Osis
Fatimah Mohammed
Khaled Mohammed Alharbi
Abdulaziz Ali Abdulaziz Aldobayan
Mohammed Fahad Mohammed Hawbani
Ramzi Hassan Ahmed Julayhi
Samir Ahmed Hassan Alwadani
Abdulrahman Ahmed Mohammed Maslmani
Hayfaa Mohammed Saad Shuraidh
Bashayr Radhi Alwan Aldhafeeri
Almarwani, M. S., Salha Ahmed Mohammed Osis, Ghosoon Ahmad Mohd Osis, Fatimah Mohammed, Khaled Mohammed Alharbi, Abdulaziz Ali Abdulaziz Aldobayan, … Bashayr Radhi Alwan Aldhafeeri. (2024). The Role of Integrated Health Informatics in Streamlining Patient Flow from Emergency Department to Admission: A Review of Administrative and Clinical Synergies. Saudi Journal of Medicine and Public Health, 1(2), 1927–1934. https://doi.org/10.64483/202412551

Article Details