JMIR Publications

ABSTRACT

Background:

Emergency-to-ICU admissions represent high‑stakes transitions in care, where delays or documentation errors can jeopardize patient safety and strain operational efficiency. Although digital order systems have the potential to streamline these processes, traditional platforms often lack real‑time coordination and traceability. As a result, they remain vulnerable to documentation errors and inefficient ICU bed reservation workflows, particularly in high‑acuity emergency settings.

Objective:

This study aimed to evaluate the impact of an updated digital order system on Emergency‑to‑ICU workflows. Specifically, we assessed whether the redesigned platform improved admission order validity, reduced documentation errors, and enhanced ICU bed reservation efficiency compared with the traditional system.

Methods:

We conducted a retrospective observational study comparing Emergency‑to‑ICU admission workflows processed through traditional (2023) and updated (2024) digital order systems at a tertiary medical center. Admission and reservation data were extracted from system logs and ICU bed management records, including total admissions, reservations, and admission‑to‑reservation ratios (beds/admission) to assess resource efficiency. Outcomes included valid and erroneous admission orders, with error subtypes classified as duplicate, lost, or tracking errors. Proportions were compared using chi‑squared tests, and odds ratios (OR) with 95% confidence intervals (CI) were calculated. Absolute risk reduction (ARR) and number needed to treat (NNT) were derived to quantify clinical impact. Poisson regression was applied to evaluate admission‑to‑reservation ratios, with Emergency‑to‑ICU admissions as the offset. Statistical significance was defined as p < 0.05.

Results:

The updated digital order system improved admission order validity from 54.1% to 75.4% (OR 2.61, 95% CI 1.96–3.46; p < 0.0001) and reduced erroneous orders from 45.9% to 24.6% (OR 0.37, 95% CI 0.27–0.50; p < 0.0001), with an absolute risk reduction (ARR) of 21.3% and number needed to treat (NNT) of 5. Subtype analysis showed significant reductions in duplicate orders (ARR 10.5%, NNT 10) and lost orders (ARR 17.6%, NNT 6), while tracking errors remained unchanged. ICU bed reservation efficiency improved, with the admission-to-reservation ratio decreasing from 1.47 to 1.29 (rate ratio 0.88, 95% CI 0.77–0.99; p = 0.034).

Conclusions:

The updated digital order system significantly demonstrated measurable improvements in Emergency to ICU admission workflows compared with the traditional platform. These findings highlight the value of informatics‑driven system redesign in strengthening clinical coordination and operational performance. Broader adoption of modular, traceable digital systems may improve patient safety and reduce administrative burden in high acuity settings. Continued refinement is warranted to address residual error categories and validate these results across diverse hospital environments. Clinical Trial: None