Until 2017, nurses at The University of Tennessee Medical Center in Knoxville, Tennessee, spent too much valuable time documenting and dealing with unnecessary navigation and duplication in the electronic health record (EHR).
"Previously, we customized it so much, no one really knew what anyone else was doing," said Brant Sloan, RN, nursing informatics coordinator. "We had 52 different places to document a pulse."
Cerner's Continuous Advancement Services team helped multiple inpatient areas across the medical center streamline documentation, reduce duplicate charting and improve access to patient information. The changes helped 1,085 nurses save more than an estimated 65,000 hours annually in the EHR.
In May 2017, more than 1,600 nurses began using the new streamlined documentation within iView. Changes included removing unused data fields and ensuring appropriate data fields only displayed at the necessary time in nurses' documentation workflow.
"They can enter and review their information quicker, and have all the information they need in one place," said Sloan. "It reduces their time in the chart, which gives them more time with the patient."
Documentation time per patient dropped more than 12 percent, which adds up to 13,524 documentation hours saved by all nurses over the course of a year.1
"It also allows them to see what other people charted more easily," said Debbie Barton, RN, administrative director of patient care services. "It's a huge nurse satisfier, but also a big patient safety component."
In addition to streamlining documentation, an organizational shift allowed the Continuous Advancement Services team to eliminate more than 2.1 million non-essential nursing tasks from firing over a six-month period, a decrease of 33 percent.2 Nurses can now chart directly in iView instead of waiting on a routine patient care task.
Reducing duplicate charting helps staff and patients alike, because there is a smaller chance of someone entering the data incorrectly, or looking at the wrong chart.
"This enhances our ability for accuracy," said Barton. "Having everybody working with the same piece of information to make patient care decisions is so important."
Other improvements included replacing free-text PowerForm with iView and custom MPages® to improve telling the patient's story within nurses' normal workflow. Previously, nurses didn't have a simple, concise system that helped them understand everything they needed to know about a patient during a shift change. Now, the new Nursing Handoff Workflow MPage lays out the necessary details about a patient, making it more concise and easier to find.
"You pretty much have the information face-up on any topic you need, from labs, to vitals to diagnostic results," said Sloan.
Leaders at The University of Tennessee Medical Center plan to continue working with Cerner's Continuous Advancement Services team.
"We'll continue to look at our data and see how we're trending versus the national average for documentation, time in the chart and medication administration," said Sloan. "We'll continue to make modification and updates, but operating from the unified understanding we're more efficient and effective with documenting something in one place."
Data from Cerner Advance helped in the optimization project.
For more on optimization projects, please visit the Acute Care Model Experience webpage.
1 Baseline of 12:16 from Feb. 5 – April 29, 2017 compared to 9:40 from Oct. 15, 2017 – Jan. 6, 2018.
2 Baseline of 4:24 from Feb. 5 - April 29, 2019 compared to 3:52 from Oct. 15, 2017 – Jan. 6, 2018.