June 2013
Volume 54, Issue 15
Free
ARVO Annual Meeting Abstract  |   June 2013
Time-Motion Analysis of Clinical Nursing Documentation during Implementation of an Electronic Operating Room Management System for Ophthalmic Surgery
Author Affiliations & Notes
  • Sarah Read-Brown
    Ophthalmology, Oregon Health & Science University, Portland, OR
  • Anna Brown
    Ophthalmology, Oregon Health & Science University, Portland, OR
  • Thomas Yackel
    Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, OR
  • Dongseok Choi
    Public Health & Preventative Medicine, Oregon Health & Science University, Portland, OR
  • Daniel Tu
    Ophthalmology, Oregon Health & Science University, Portland, OR
    Portland Veterans Administration Medical Center, Portland, OR
  • David Sanders
    Ophthalmology, Oregon Health & Science University, Portland, OR
  • Michael Chiang
    Ophthalmology, Oregon Health & Science University, Portland, OR
    Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, OR
  • Footnotes
    Commercial Relationships Sarah Read-Brown, None; Anna Brown, None; Thomas Yackel, None; Dongseok Choi, None; Daniel Tu, Research to Prevent Blindness (F); David Sanders, Supported by unrestricted departmental funding by Research to Prevent Blindness (New York, NY) (F); Michael Chiang, Clarity Medical Systems (unpaid member of Scientific Advisory Board) (S)
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2013, Vol.54, 4548. doi:
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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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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

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.

 
Methods
 

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.

 
Results
 

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.

 
Conclusions
 

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.

 
 
Figure 1. Mean ophthalmic nurse documentation time per case.
 
Figure 1. Mean ophthalmic nurse documentation time per case.
 
Keywords: 465 clinical (human) or epidemiologic studies: systems/equipment/techniques • 460 clinical (human) or epidemiologic studies: health care delivery/economics/manpower • 462 clinical (human) or epidemiologic studies: outcomes/complications  
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