Impact of an electronic health record operating room management system in ophthalmology on documentation time, surgical volume, and staffing

David S. Sanders, Sarah Read-Brown, Daniel Tu, William Lambert, Dongseok Choi, Bella M. Almario, Thomas Yackel, Anna S. Brown, Michael Chiang

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

OBJECTIVE To determine the impact of an EHR OR management system on intraoperative nursing documentation time, surgical volume, and staffing requirements. DESIGN, SETTING, AND PARTICIPANTS For documentation time and circulating nurses per procedure, a prospective cohort design was used between January 10, 2012, and January 10, 2013. For surgical volume and overall staffing requirements, a case series design was used between January 29, 2011, and January 28, 2013. This study involved ophthalmic OR nurses (n = 13) and surgeons (n = 25) at an academic medical center. EXPOSURES Electronic health record OR management system implementation. MAIN OUTCOMES AND MEASURES (1) Documentation time (percentage of operating time documenting [POTD], absolute documentation time in minutes), (2) surgical volume (procedures/time), and (3) staffing requirements (full-time equivalents, circulating nurses/procedure). Outcomes were measured during a baseline period when paper documentation was used and during the early (first 3 months) and late (4-12 months) periods after EHR implementation. RESULTS There was a worsening in total POTD in the early EHR period (83%) vs paper baseline (41%) (P <.001). This improved to baseline levels by the late EHR period (46%, P = .28), although POTD in the cataract group remained worse than at baseline (64%, P <.001). There was a worsening in absolute mean documentation time in the early EHR period (16.7 minutes) vs paper baseline (7.5 minutes) (P <.001). This improved in the late EHR period (9.2 minutes) but remained worse than in the paper baseline (P <.001). While cataract procedures required more circulating nurses in the early EHR (mean, 1.9 nurses/procedure) and late EHR (mean, 1.5 nurses/procedure) periods than in the paper baseline (mean, 1.0 nurses/procedure) (P <.001), overall staffing requirements and surgical volume were not significantly different between the periods. CONCLUSIONS AND RELEVANCE Electronic health record OR management system implementation was associated with worsening of intraoperative nursing documentation time especially in shorter procedures. However, it is possible to implement an EHR OR management system without serious negative impacts on surgical volume and staffing requirements.

Original languageEnglish (US)
Pages (from-to)586-592
Number of pages7
JournalJAMA Ophthalmology
Volume132
Issue number5
DOIs
StatePublished - 2014

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Electronic Health Records
Ophthalmology
Operating Rooms
Documentation
Nurses
Forms and Records Control
Cataract
Nursing
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Ophthalmology

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Impact of an electronic health record operating room management system in ophthalmology on documentation time, surgical volume, and staffing. / Sanders, David S.; Read-Brown, Sarah; Tu, Daniel; Lambert, William; Choi, Dongseok; Almario, Bella M.; Yackel, Thomas; Brown, Anna S.; Chiang, Michael.

In: JAMA Ophthalmology, Vol. 132, No. 5, 2014, p. 586-592.

Research output: Contribution to journalArticle

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abstract = "OBJECTIVE To determine the impact of an EHR OR management system on intraoperative nursing documentation time, surgical volume, and staffing requirements. DESIGN, SETTING, AND PARTICIPANTS For documentation time and circulating nurses per procedure, a prospective cohort design was used between January 10, 2012, and January 10, 2013. For surgical volume and overall staffing requirements, a case series design was used between January 29, 2011, and January 28, 2013. This study involved ophthalmic OR nurses (n = 13) and surgeons (n = 25) at an academic medical center. EXPOSURES Electronic health record OR management system implementation. MAIN OUTCOMES AND MEASURES (1) Documentation time (percentage of operating time documenting [POTD], absolute documentation time in minutes), (2) surgical volume (procedures/time), and (3) staffing requirements (full-time equivalents, circulating nurses/procedure). Outcomes were measured during a baseline period when paper documentation was used and during the early (first 3 months) and late (4-12 months) periods after EHR implementation. RESULTS There was a worsening in total POTD in the early EHR period (83{\%}) vs paper baseline (41{\%}) (P <.001). This improved to baseline levels by the late EHR period (46{\%}, P = .28), although POTD in the cataract group remained worse than at baseline (64{\%}, P <.001). There was a worsening in absolute mean documentation time in the early EHR period (16.7 minutes) vs paper baseline (7.5 minutes) (P <.001). This improved in the late EHR period (9.2 minutes) but remained worse than in the paper baseline (P <.001). While cataract procedures required more circulating nurses in the early EHR (mean, 1.9 nurses/procedure) and late EHR (mean, 1.5 nurses/procedure) periods than in the paper baseline (mean, 1.0 nurses/procedure) (P <.001), overall staffing requirements and surgical volume were not significantly different between the periods. CONCLUSIONS AND RELEVANCE Electronic health record OR management system implementation was associated with worsening of intraoperative nursing documentation time especially in shorter procedures. However, it is possible to implement an EHR OR management system without serious negative impacts on surgical volume and staffing requirements.",
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N2 - OBJECTIVE To determine the impact of an EHR OR management system on intraoperative nursing documentation time, surgical volume, and staffing requirements. DESIGN, SETTING, AND PARTICIPANTS For documentation time and circulating nurses per procedure, a prospective cohort design was used between January 10, 2012, and January 10, 2013. For surgical volume and overall staffing requirements, a case series design was used between January 29, 2011, and January 28, 2013. This study involved ophthalmic OR nurses (n = 13) and surgeons (n = 25) at an academic medical center. EXPOSURES Electronic health record OR management system implementation. MAIN OUTCOMES AND MEASURES (1) Documentation time (percentage of operating time documenting [POTD], absolute documentation time in minutes), (2) surgical volume (procedures/time), and (3) staffing requirements (full-time equivalents, circulating nurses/procedure). Outcomes were measured during a baseline period when paper documentation was used and during the early (first 3 months) and late (4-12 months) periods after EHR implementation. RESULTS There was a worsening in total POTD in the early EHR period (83%) vs paper baseline (41%) (P <.001). This improved to baseline levels by the late EHR period (46%, P = .28), although POTD in the cataract group remained worse than at baseline (64%, P <.001). There was a worsening in absolute mean documentation time in the early EHR period (16.7 minutes) vs paper baseline (7.5 minutes) (P <.001). This improved in the late EHR period (9.2 minutes) but remained worse than in the paper baseline (P <.001). While cataract procedures required more circulating nurses in the early EHR (mean, 1.9 nurses/procedure) and late EHR (mean, 1.5 nurses/procedure) periods than in the paper baseline (mean, 1.0 nurses/procedure) (P <.001), overall staffing requirements and surgical volume were not significantly different between the periods. CONCLUSIONS AND RELEVANCE Electronic health record OR management system implementation was associated with worsening of intraoperative nursing documentation time especially in shorter procedures. However, it is possible to implement an EHR OR management system without serious negative impacts on surgical volume and staffing requirements.

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