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Changes to Workflow and Process Measures in the PICU During Transition From Semi to Full Electronic Health Record
Mina Salib1, Raymond G Hoffmann, Mahua Dasgupta
11Critical Care Section, Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee, WI. 2Department of Pediatrics at Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI. 3Section of Quantitative Health Sciences at Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI.
Insights
Implementing a full electronic health record in a pediatric intensive care unit (PICU) streamlined clinical workflows. This transition significantly reduced time for rounds, final notes, and medication administration, improving efficiency.
Area of Science:
- Healthcare Informatics
- Clinical Workflow Analysis
- Pediatric Critical Care Medicine
Background:
- Transitioning to full electronic health records (EHRs) in healthcare settings is ongoing.
- Limited studies document workflow changes during the shift from semi-electronic to full EHR systems.
- Understanding these workflow dynamics is crucial for optimizing patient care in intensive care units.
Purpose of the Study:
- To identify and quantify changes in clinical workflow within a pediatric intensive care unit (PICU) during the transition from a semi-electronic to a full electronic health record system.
- To provide data on workflow adjustments in a critical care setting during EHR implementation.
Main Methods:
- A prospective observational study was conducted in a 72-bed PICU.
- Clinical workflow variables were measured during three phases: pre-EHR (baseline), transition (3 weeks post-EHR), and stabilization (6 months post-EHR).
- Data from 564 patients (2,355 patient days) were analyzed using the Mann-Whitney U test.
Main Results:
- Duration of physician rounds decreased from 9 to 7 minutes per patient.
- Time to final note completion reduced from 2.06 days to 0.5 days.
- Time to first medication administration post-admission decreased from 33 to 7 minutes; medication reconciliation time and completion rates also improved.
Conclusions:
- The implementation of a full electronic health record system significantly optimized clinical workflow in the PICU.
- Key improvements included reduced time for rounds, note finalization, medication administration, and enhanced medication reconciliation.
- No significant change was observed in the time from discharge order to physical transfer.
Objectives:
Studies showing the changes in workflow during transition from semi to full electronic medical records are lacking. This objective study is to identify the changes in workflow in the PICU during transition from semi to full electronic health record.
Design:
Prospective observational study. Children's Hospital of Wisconsin Institutional Review Board waived the need for approval so this study was institutional review board exempt. This study measured clinical workflow variables at a 72-bed PICU during different phases of transition to a full electronic health record, which occurred on November 4, 2012. Phases of electronic health record transition were defined as follows: pre-electronic health record (baseline data prior to transition to full electronic health record), transition phase (3 wk after electronic health record), and stabilization (6 mo after electronic health record). Data were analyzed for the three phases using Mann-Whitney U test with a two-sided p value of less than 0.05 considered significant.
Setting:
Seventy-two bed PICU.
Patients:
All patients in the PICU were included during the study periods.
Measurements And Main Results:
Five hundred and sixty-four patients with 2,355 patient days were evaluated in the three phases. Duration of rounds decreased from a median of 9 minutes per patient pre--electronic health record to 7 minutes per patient post electronic health record. Time to final note decreased from 2.06 days pre--electronic health record to 0.5 days post electronic health record. Time to first medication administration after admission also decreased from 33 minutes pre--electronic health record and 7 minutes post electronic health record. Time to Time to medication reconciliation was significantly higher pre-electronic health record than post electronic health record and percent of medication reconciliation completion was significantly lower pre--electronic health record than post electronic health record and percent of medication reconciliation completion was significantly higher pre--electronic health record than. There was no significant change in time between placement of discharge order and physical transfer from the unit [corrected].changes clinical workflow in a PICU with decreased duration of rounds, time to final note, time to medication administration, and time to medication reconciliation completion. There was no change in the duration from medical to physical transfer.
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