Aim background

Many health care services are implementing or planning to undergo digital transformation to keep pace with increasing Electronic Medical Record (EMR) functionality. The aim of this study was to objectively measure nursing care delivery before and following introduction of an EMR.

Design and methods

An extensive program of work to expand an EMR across our health service using a ‘big bang’ methodology was undertaken. The program incorporated digital care delivery workflows including physiological observations, clinical notes and closed loop medication management. The validated Work Observation Method by Activity Timing (WOMBAT) method was applied to undertake a direct observational time and motion study of nurses’ work in a major Australian hospital immediately prior to and six months following the introduction of a full clinical EMR.

Results

Time and motion results were from observing approximately one week of nursing time pre (paper) to six months post (EMR) implementation. A non-significant 6.4% increase in the proportion of time spent on direct care was observed when using the EMR with a statistically significant increase in mean time per direct care task (2.5 min vs 3.9 min, p = 0.001). The proportion of time spent on medication-related activities did not significantly change although the average time per task rose from 2.0 to 2.9 min (p = 0.008). A significant reduction in proportion of time spent in transit and indirect care tasks when using the electronic workflows was reported. No statistically significant changes to the proportions of time spent on professional communication, direct care or documentation were observed.

Conclusions

Successful EMR implementation is possible without adversely affecting allocation of nursing time. Our findings from deploying a large scale EMR across all healthcare craft groups and workflows have described for nurses that an EMR enables them to spend longer with patients per direct care episode and use their time on other activities more effectively.

中文翻译：

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一项纵向时间和运动研究，量化电子病历的实施如何影响医院护士的护理服务

目标背景

许多医疗保健服务正在实施或计划进行数字化转型，以跟上日益增长的电子病历 (EMR) 功能。本研究的目的是客观地衡量引入 EMR 之前和之后的护理服务。

设计和方法

开展了一项广泛的工作计划，以使用“大爆炸”方法在我们的卫生服务中扩展 EMR。该计划结合了数字护理交付工作流程，包括生理观察、临床记录和闭环药物管理。使用经过验证的活动计时工作观察法 (WOMBAT) 方法对澳大利亚一家主要医院的护士工作进行了直接观察时间和运动研究，即在引入完整的临床 EMR 之前和之后六个月。

结果

时间和运动结果来自观察大约一周的护理时间（论文）到六个月后（EMR）实施。当使用 EMR 时，观察到直接护理花费的时间比例非显着增加 6.4%，每个直接护理任务的平均时间有统计学显着增加（2.5 分钟 vs 3.9 分钟，p  = 0.001）。尽管每项任务的平均时间从 2.0 分钟上升到 2.9 分钟（p = 0.008）。据报道，使用电子工作流程时，在运输和间接护理任务中花费的时间比例显着减少。没有观察到专业交流、直接护理或记录所花费的时间比例在统计上有显着变化。

结论

成功实施 EMR 是可能的，而不会对护理时间的分配产生不利影响。我们在所有医疗保健工艺组和工作流程中部署大规模 EMR 的结果表明，对于护士而言，EMR 使他们能够在每次直接护理事件中花费更长时间与患者相处，并更有效地将时间用于其他活动。