Improving Workflow Efficiency in Nursing
Handout (458.2 kB)
The prior electronic medical record (EMR) did not interface with other operating systems creating a fragmented patient experience. The purpose was to evaluate the effects of an integrated EMR system in comparison to a partially computerized EMR on workflow efficiency in nurses' documentation.
Relevance/Significance:
Nurses were experiencing major barriers including but not limited to 16 character limitations, no hard stops or reminders, no design modifications, limited ability to free text, no hover features, duplicate entry of information in multiple places/times, minimal electronic reports, and/or no logic associated with the system. Nurse productivity was low and ultimately would affect nurses' ability to provide safe, quality patient care.
Strategy and Implementation:
A pre-post design was used. Nurses were recruited from a five-hospital healthcare system. Baseline data were collected from January 2012 to March 2012 and included 165 nurses who consented to participate with 255 observations conducted. Post-data were collected from December 2014 to February 2015 included 239 nurses who consented to participate with 529 observations conducted. Time study observations were conducted on morning, evening, and night shifts by trained observers. Intraclass reliability estimates indicated a high degree of consistency across raters. Data collection logs were collected at baseline and post to ensure logs were accurate. Observations started when the nurse started a documentation activity, if interruptions occurred, the timer stopped, and restarted once the nurse returned to the activity. Each nursing documentation activity (observation category) and documentation location (EMR) were defined to ensure observers were consistent with observations.
Evaluation:
Baseline nurses' spent most time documenting discharges (Mdn=21 min) with significant improvements found post (Mdn=12 min) (t=3.66, P=. 000). Similarly, nurses spent time documenting admissions (Mdn=20.5 min) and significant improvements were found post (Mdn=12 min) (t=4.21, P=. 000). Significant improvements were also observed for care plans (t=2.29, P=. 02) and education (t=2.88, P=. 01).
Implications for Practice:
Technology can improve nurse efficiency by eliminating inefficient workflows. Findings provided a better understanding of the impact that a fully integrated EMR had on nurses' ability to perform more efficiently.