Workflow Improvement of Electronic Health Record Usage in a Tertiary Pediatric Burns Clinic

Abstract

Background As a high patient-throughput clinic, the Royal Children's Hospital's multidisciplinary burns clinic's efficiency of clinic workflow and streamlined patient assessment is crucial. The clinic has been using a customized “burns assessment tool” (BAT) as part of its integrated electronic health record (EHR) since 2016.

Objectives The aim was to assess the usage patterns of the BAT at baseline, followed by re-evaluation following interventions to improve efficiency and utilization of the BAT.

Methods This study was a prospective observational time–motion quality improvement study. Observations of 19 clinicians in the pediatric burns clinic by five trained observers using a validated time–motion capture tool (TimeCaT 3.9) to map clinician workflow, with specific reference to time spent on a list of predetermined tasks, were conducted. Baseline data were collected for 7 weeks followed by three cycles of interventions and observations over 5 months.

Results At baseline, the median time for a patient visit was 24.56 minutes (range: 2.78–73.72 minutes, interquartile range: 14.17–27 minutes), with most of the time spent on documentation (34.6%) and patient contact tasks (26.0%). In each of the study cycles, the median time spent on documentation within the EHR was significantly reduced compared with baseline (cycle 1 29.8%, p = 0.08; cycle 2 20.4%, p ≤ 0.01; cycle 3 27.32%, p = 0.04). The time spent on patient contact increased when comparing baseline to data of cycles 1, 2, and 3 (25.96 vs. 33.27% of visit, p = 0.04). There was no significant change in absolute time spent on the BAT during the study.

Conclusion The study findings of clear, significant, and sustained improvement in documentation efficiency and the corresponding increase in patient contact time after interventions were introduced reinforce the importance of integration of an EHR with clinical workflow.

Keywords

workflow - electronic health records - burns - clinic - ambulatory

Protection of Human and Animal Subjects

No human subjects were involved in the project. This was a study of EHR use where human subjects were not part of the research question.

Publikationsverlauf

Eingereicht: 20. September 2022

Angenommen: 01. Januar 2023

Artikel online veröffentlicht:
15. März 2023

• References

• 1 Friedberg MW, Chen PG, Van Busum KR. et al. Factors affecting physician professional satisfaction and their implications for patient care, health systems, and health policy. Rand Health Q 2014; 3 (04) 1
• 2 Meyerhoefer CD, Sherer SA, Deily ME. et al. Provider and patient satisfaction with the integration of ambulatory and hospital EHR systems. J Am Med Inform Assoc 2018; 25 (08) 1054-1063
• 3 Shanafelt TD, Dyrbye LN, Sinsky C. et al. Relationship between clerical burden and characteristics of the electronic environment with physician burnout and professional satisfaction. Mayo Clin Proc 2016; 91 (07) 836-848
• 4 Goldstein IH, Hribar MR, Reznick LG, Chiang MF. Analysis of total time requirements of electronic health record use by ophthalmologists using secondary EHR data. AMIA Annu Symp Proc 2018; 2018: 490-497
• 5 Goldstein IH, Hribar MR, Sarah R-B, Chiang MF. Quantifying the impact of trainee providers on outpatient clinic workflow using secondary EHR data. AMIA Annu Symp Proc 2018; 2017: 760-769
• 6 Vahdat V, Griffin JA, Stahl JE, Yang FC. Analysis of the effects of EHR implementation on timeliness of care in a dermatology clinic: a simulation study. J Am Med Inform Assoc 2018; 25 (07) 827-832
• 7 Hampe HM, Keeling T, Fontana M, Balcik D. Impacting care and treatment of the burn patient conversion to electronic documentation. Crit Care Nurs Q 2017; 40 (01) 8-15
• 8 Lopetegui M, Yen P-Y, Lai AM, Embi PJ, Payne PR. Time Capture Tool (TimeCaT): development of a comprehensive application to support data capture for time motion studies. AMIA Annu Symp Proc 2012; 2012: 596-605
• 9 Jedwab RM, Franco M, Owen D, Ingram A, Redley B, Dobroff N. Improving the quality of electronic medical record documentation: development of a compliance and quality program. Appl Clin Inform 2022; 13 (04) 836-844
• 10 de Groot S, Lawrence J, Liddle J, Campbell J, Cheng DR. Improving asthma care documentation with a digital tool-experience in a pediatric institution. Appl Clin Inform 2022; 13 (04) 956-960
• 11 English EF, Holmstrom H, Kwan BW. et al. Virtual sprint outpatient electronic health record training and optimization effect on provider burnout. Appl Clin Inform 2022; 13 (01) 10-18
• 12 Rumball-Smith J, Shekelle P, Damberg CL. Electronic health record “super-users” and “under-users” in ambulatory care practices. Am J Manag Care 2018; 24 (01) 26-31
• 13 Kutney-Lee A, Sloane DM, Bowles KH, Burns LR, Aiken LH. Electronic health record adoption and nurse reports of usability and quality of care: the role of work environment. Appl Clin Inform 2019; 10 (01) 129-139
• 14 Sinsky C, Colligan L, Li L. et al. Allocation of physician time in ambulatory practice: a time and motion study in 4 specialties. Ann Intern Med 2016; 165 (11) 753-760
• 15 Young RA, Burge SK, Kumar KA, Wilson JM, Ortiz DF. A time-motion study of primary care physicians' work in the electronic health record era. Fam Med 2018; 50 (02) 91-99
• 16 Schmajuk G, Yazdany J. Leveraging the electronic health record to improve quality and safety in rheumatology. Rheumatol Int 2017; 37 (10) 1603-1610
• 17 Carter JT. Electronic medical records and quality improvement. Neurosurg Clin N Am 2015; 26 (02) 245-251 , ix