Electronic Records With Tablets at the Point of Care in an Internal Medicine Unit: Before-After Time Motion Study

Abstract

Background There are many benefits of nursing professionals being able to consult electronic health records (EHRs) at the point of care. It promotes quality and patient security, communication, continuity of care, and time dedicated to records. Objective The aim of this study was to evaluate whether making EHRs available at the point of care with tablets reduces nurses’ time spent on records compared with the current system. The analysis included sociodemographic and qualitative variables, time spent per patient, and work shift. This time difference can be used for direct patient care. Methods A before-after time motion study was carried out in the internal medicine unit. There was a total of 130 observations of 2 hours to 3 hours in duration of complete patient records that were carried out at the beginning of the nurses' work shifts. We calculated the time dedicated to measuring vital signs, patient evaluation, and EHR recording. The main variable was time spent per patient. Results The average time spent per patient (total time/patients admitted) was lower with the tablet group (mean 4.22, SD 0.14 minutes) than with the control group (mean 4.66, SD 0.12 minutes); there were statistically significant differences (W=3.20, P=.001) and a low effect (d=.44) between groups. The tablet group saved an average of 0.44 (SD 0.13) minutes per patient. Similar results were obtained for the afternoon shift, which saved an average of 0.60 (SD 0.15) minutes per patient (t34=3.82, P=.01) and high effect (d=.77). However, although there was a mean difference of 0.26 (SD 0.22) minutes per patient for the night shift, this was not statistically significant (t29=1.16, P=.25). The “nonparticipating” average age was higher (49.57, SD 2.92 years) compared with the “afternoon shift participants” and “night shift participants” (P=.007). “Nonparticipants” of the night shift had a worse perception of the project. Conclusions This investigation determined that, with EHRs at the point of care, the time spent for registration by the nursing staff decreases, because of reduced movements and avoiding data transcription. It eliminates unnecessary work that does not add value, and therefore, care is improved. So, we think EHRs at the point of care should be the future or natural method for nursing to undertake. However, variables that could have a negative effect include age, night shift, and nurses’ perceptions. Therefore, it is proposed that training in the different work platforms and the participation of nurses are fundamental axes that any institution should consider before their implementation.

Experiences of Electronic Health Records’ and Client Information Systems’ Use on a Mobile Device and Factors Associated With Work Time Savings Among Practical Nurses: Cross-Sectional Study

“…In this study, we found that two-thirds of the practical nurses who worked in home care or service housing perceived work time savings when they were using EHR/CIS on a mobile device. Similar work time savings have been reported in previous studies of healthcare professionals [14,20,21]. This study showed that documenting client data in a public area, for example in a corridor of a housing service, made work time savings over two times more likely than documenting at the (nurses') office, where computers are typically available.…”

“…In the health care sector, saving work time is crucial because nursing professionals are tasked with a multitude of responsibilities in their daily practice. It is essential for them to have more time available for direct patient care and to minimize the time spent on indirect patient care activities, such as documentation [ 21 ].…”

“…We were particularly interested in examining whether the use of EHR/CIS on a mobile device saves practical nurses working time and which factors were associated with work time savings. In the healthcare sector, saving work time is an important issue, as nursing professionals need to carry out numerous tasks in their daily practice and they should have more time for immediate patient care and spend less time on indirect patient care such as working with documentation [21].…”

“…In fact, it is important to recognize that the use of different technological systems such as EHRs has been shown to provide nurses with more time for direct patient care and interprofessional communication [ 19 ]. Moreover, mobile devices have been reported to be useful for planning work, handling notes [ 14 ], and saving time for nurses [ 14 , 20 , 21 ]. Mobile devices may also reduce duplicate documentation [ 13 ] and potential documentation errors [ 17 , 20 ] because client data can be documented at the time of its occurrence.…”

Data Quality–Driven Improvement in Health Care: Systematic Literature Review

“…For example, time-related data items can be used to measure how close to the event the data describes was the information recorded. Factors affecting timely capture of EHR-data include workflow inefficiencies, documentation burden, limited access to hardware, and interruptions [43][44][45][46][47][48]. Batch processing of data long after the event may indicate a lack of timeliness and affects other DQ dimensions such as completeness, accuracy, and validity [28,44,46,48,49].…”