BackgroundLittle is known about optimisation of electronic health records (EHRs) systems in the hospital setting while adoption of EHR systems continues in the United States.ObjectiveTo understand optimisation processes of EHR systems undertaken in leading healthcare organisations in the United States.MethodsInformed by a grounded theory approach, a qualitative study was undertaken that involved 11 in-depth interviews and a focus group with the EHR experts from the high performing healthcare organisations across the United States.ResultsThe study describes EHR optimisation processes characterised by prioritising exponentially increasing requests with predominant focus on improving efficiency of EHR, building optimisation teams or advisory groups and standardisation. The study discusses 16 types of optimisation that interdependently produced 16 results along with identifying 11 barriers and 20 facilitators to optimisation.ConclusionsThe study describes overall experiences of optimising EHRs in select high performing healthcare organisations in the US. The findings highlight the importance of optimising the EHR after, and even before, go-live and dedicating resources exclusively for optimisation.

OBJECTIVE Rush University Medical Center nursing leadership undertook a process improvement project to revamp nursing handoff during unit transfer with the goal of improving patient throughput. The aim was to decrease assign-to-occupy time, the duration from bed assignment to bed occupancy. BACKGROUND There was a lengthy lag time in admitting/transferring patients, leading to delays in patient throughput and potential threats to patient safety. In fiscal year 2016, assign-to-occupy time averaged 97 minutes. The goal was to decrease that time to 60 minutes or less. METHODS Process improvement leaders held a rapid improvement event to determine viable solutions. A team then standardized handoff workflow; created an electronic tool, virtually eliminating verbal report; and implemented a new handoff process. RESULTS Assign-to-occupy time at 1 year after go-live averaged 55 minutes, and it has been staying less than 60 minutes since the implementation. CONCLUSIONS Key success strategies included engaging stakeholders during the rapid improvement event, imploring frontline nurses to create and promote the revised process to facilitate staff engagement, and leveraging electronic health records.