Electronic Medical Record Audit Time Logs as a Measure of Preoperative Work Before Total Joint Arthroplasty

In order to achieve rapid recovery total joint arthroplasty, surgeons and their teams are spending more time in the weeks before surgery to prepare patients. This study aims to quantify total knee and hip prearthroplasty work using retrospective electronic medical record (EMR) activity audit log analysis.

EMR activity in 100 elective knee and 100 elective hip arthroplasty cases was performed using audit logs. Each mouse click and action in the EMR was recorded. The time between mouse clicks was calculated and summed for each member of the clinical team. Descriptive statistics and independent samples t-tests were conducted to quantify and compare total preoperative work (POW) between groups defined by gender, procedure, age, insurance type, or health literacy (P < .05).

The mean number of days defined in the prearthroplasty time period was 69.1 days (standard deviation [SD] 42.8; range 8-191). The mean time spent in each patient's chart in the prearthroplasty period was 76.8 (SD 47.8) minutes. Surgeon's work in the medical record accounted for 7.9 (SD 7.9) minutes, registered nurses 46.7 minutes (SD 39.1), physician extenders 10.8 minutes (SD 16.9), and licensed practical nurses and patient care technicians 9.8 minutes (SD 13.0). A significant difference was observed when groups were dichotomized based on age <65 and insurance provider type.

A considerable amount of POW is required to prepare patients for surgery from the clinic date one decides to pursue total joint arthroplasty and the day prior to surgery. Retrospective electronic time stamps from the EMR should represent the minimum time required for surgical preparation.