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Sarah Read-Brown, Anna Brown, Thomas Yackel, Dongseok Choi, Daniel Tu, David Sanders, Michael Chiang; Time-Motion Analysis of Clinical Nursing Documentation during Implementation of an Electronic Operating Room Management System for Ophthalmic Surgery. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4548.
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The efficiency and quality of clinical documentation are critical in surgical settings because operating rooms are a major source of hospital revenue, and because adverse events may have enormous consequences. Electronic health records (EHR) have the potential to impact surgical quality, workflow, and documentation time. We aim to examine the speed of intra-operative nursing documentation during the implementation of an EHR operating room management system for ambulatory ophthalmology surgery.
In January 2012, Oregon Health & Sciences University (OHSU) implemented an EHR operating room management system throughout the institution (OpTime; Epic Systems, Madison, WI), replacing paper-based documentation. Using a paper log sheet and time stamping software, time-motion data was collected by a single observer who shadowed the nurse responsible for documentation in the surgical suite of the ophthalmology department at OHSU. Data was collected for 3 weeks pre-implementation (paper), and 10 months post-implementation (EHR). Descriptive statistics and a mixed-effects model were used to analyze data.
During the 11-month study period, 238 cases were observed (58 pre-implementation, 151 post-implementation) representing 13 nurses, 22 ophthalmic surgeons, and 5 ophthalmic sub-specialties. Baseline mean ± SD paper documentation time/case was 7.5 ± 2.7 minutes. In the first 2 weeks post-EHR implementation, this increased to 19.9 ± 10.3 minutes (p<.001). In the months following implementation the documentation time/case decreased reaching a steady level after 17 weeks at 9.4 ± 2.8 minutes per case, but was slower than with paper documentation (p<.001). Post-implementation, there was significant variation in documentation time among nurses 11.4 ± 4.0 minutes (p<.001), although the variation among nurses decreased over time.
Ophthalmic nursing documentation time requirements increased significantly with EHR compared to paper, but this improved to a steady level after several months that remained slower than the paper baseline. EHR implementation seemed to affect some ophthalmic nurses more than others, though the variation among nurses decreased with time. These finding have implications for implementation and delivery of ophthalmic surgical care using EHRs.
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