When patients arrive at an emergency department (ED) seeking care, they are triaged to determine their acuity level, often using the Emergency Severity Index (ESI).1 This index helps determine the order of care among patients, with level 1 denoting the most critical cases and level 5 representing the least critical.2 Existing research has shown that health information exchange (HIE) through platforms like Epic’s Care Everywhere has had a significant impact on various ED outcomes such as visit length, imaging, admission rates, and charges.3 The presence of Care Everywhere documents in a patient’s chart indicates that the patient has a record at another organization, including organizations that use other electronic health records and federal agencies, that has been sent to the organization where the patient is receiving care. We sought to understand whether the presence of Care Everywhere documents in the patient’s chart correlates with a reduced risk of code blue events in the ED. Code blue events are a medical emergency where a patient requires immediate resuscitation, often due to cardiac or respiratory arrest.
We studied 95 million ED visits between January 1, 2017, and October 1, 2023, with an ESI level of 1, 2, or 3. Of those, 82 million had Care Everywhere documents present. We excluded patients with an unknown ESI or an ESI level 4 or 5 as there are likely more variables for the cause of the code blue.
We found that patients aged 34 and older with an ESI level of 1, 2, or 3 had a reduced risk of code blue events when Care Everywhere documents were present. For younger patients aged 18 to 33, there was a reduced risk of code blue events for ESI levels 1 and 2, while those under 18 years of age had a reduced risk for level 1.
We conducted sensitivity analyses to account for variables such as care received in the prior year and the volume of visits prior to the ED visit and found comparable results. In addition, we studied only patients with a minimum of five years of data in Cosmos.
