scholarly journals A Time Motion Study Evaluating the Impact of Geographic Cohorting of Hospitalists

2019 ◽  
Vol 15 (6) ◽  
Keyword(s):  
Multilevel Modeling ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Direct Care ◽  
Time Motion ◽  
Motion Study ◽  
Indirect Care ◽  
The Impact ◽  
Computer Interactions

BACKGROUND: Geographic cohorting (GCh) localizes hospitalists to a unit. Our objective was to compare the GCh and non-GCh workday. METHODS: In an academic, Midwestern hospital we observed hospitalists in GCh and non-GCh teams. Time in patient rooms was considered direct care; other locations were considered ‘indirect’ care. Geotracking identified time spent in each location and was obtained for 17 hospitalists. It was supplemented by in-person observation of four GCh and four non-GCh hospitalists for a workday each. Multilevel modeling was used to analyze associations between direct and indirect care time and team and workday characteristics. RESULTS: Geotracking yielded 10,522 direct care episodes. GCh was associated with longer durations of patient visits while increasing patient loads were associated with shorter visits. GCh, increasing patient loads, and increasing numbers of units visited were associated with increased indirect care time. In-person observations yielded 3,032 minutes of data. GCh hospitalists were observed spending 56% of the day in computer interactions vs non-GCh hospitalists (39%; P < .005). The percentage of time spent multitasking was 18% for GCh and 14% for non-GCh hospitalists (P > .05). Interruptions were pervasive, but the highest interruption rate of once every eight minutes in the afternoon was noted in the GCh group. CONCLUSION: GCh may have the potential to increase patient–hospitalist interactions but these gains may be attenuated if patient loads and the structure of cohorting are suboptimal. The hospitalist workday is cognitively intense. The interruptions noted may increase the time taken for time-intensive tasks like electronic medical record interactions.

scholarly journals Assessing the impact of a primary care electronic medical record system in three Kenyan rural health centers

2015 ◽  
Vol 23 (3) ◽  
pp. 544-552 ◽  
Author(s):  
William M Tierney ◽  
John E Sidle ◽  
Lameck O Diero ◽  
Allan Sudoi ◽  
Jepchirchir Kiplagat ◽  
...  
Keyword(s):  
Primary Care ◽  
Patient Care ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Health Centers ◽  
Hiv Care ◽  
Record System ◽  
Time Motion ◽  
Public Health Reporting ◽  
The Impact

Objective Efficient, effective health care requires rapid availability of patient information. We designed, implemented, and assessed the impact of a primary care electronic medical record (EMR) in three rural Kenyan health centers. Method Local clinicians identified data required for primary care and public health reporting. We designed paper encounter forms to capture these data in adult medicine, pediatric, and antenatal clinics. Encounter form data were hand-entered into a new primary care module in an existing EMR serving onsite clinics serving patients infected with the human immunodeficiency virus (HIV). Before subsequent visits, Summary Reports were printed containing selected patient data with reminders for needed HIV care. We assessed effects on patient flow and provider work with time-motion studies before implementation and two years later, and we surveyed providers’ satisfaction with the EMR. Results Between September 2008 and December 2011, 72 635 primary care patients were registered and 114 480 encounter forms were completed. During 2011, 32 193 unique patients visited primary care clinics, and encounter forms were completed for all visits. Of 1031 (3.2%) who were HIV-infected, 85% received HIV care. Patient clinic time increased from 37 to 81 min/visit after EMR implementation in one health center and 56 to 106 min/visit in the other. However, outpatient visits to both health centers increased by 85%. Three-quarters of increased time was spent waiting. Despite nearly doubling visits, there was no change in clinical officers’ work patterns, but the nurses’ and the clerks’ patient care time decreased after EMR implementation. Providers were generally satisfied with the EMR but desired additional training. Conclusions We successfully implemented a primary care EMR in three rural Kenyan health centers. Patient waiting time was dramatically lengthened while the nurses’ and the clerks’ patient care time decreased. Long-term use of EMRs in such settings will require changes in culture and workflow.

scholarly journals Adult Learning Principles and Peer Delivery Improve Satisfaction of Electronic Medical Record Onboarding Education

ACI Open ◽  
2020 ◽  
Vol 04 (02) ◽  
pp. e114-e118
Author(s):  
Joanna Lawrence ◽  
Sharman Tan Tanny ◽  
Victoria Heaton ◽  
Lauren Andrew
Keyword(s):  
Adult Learning ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Junior Doctors ◽  
Free Text ◽  
Organizational Safety ◽  
Adult Learning Principles ◽  
Learning Practices ◽  
Learning Principles ◽  
The Impact

Abstract Objectives Given the importance of onboarding education in ensuring the safety and efficiency of medical users in the electronic medical record (EMR), we re-designed our EMR curriculum to incorporate adult learning principles, informed and delivered by peers. We aimed to evaluate the impact of these changes based on their satisfaction with the training. Methods A single site pre- and post-observational study measured satisfaction scores (four questions) from junior doctors attending EMR onboarding education in 2018 (pre-implementation) compared with 2019 (post-implementation). An additional four questions were asked in the post-implementation survey. All questions employed a Likert scale (1–5) with an opportunity for free-text. Raw data were used to calculate averages, standard deviations and the student t-test was used to compare the two cohorts where applicable. Results There were a total of 98 respondents in 2018 (pre-implementation) and 119 in 2019 (post-implementation). Satisfaction increased from 3.8/5 to 4.5/5 (p < 0.0001) following implementation of a peer-delivered curriculum in line with adult learning practices. The highest-rated factors were being taught by other doctors (4.9/5) and doctors having the appropriate knowledge to deliver training (4.9/5). Ninety-two percent of junior doctors were motivated to engage in further EMR education and 90% felt classroom support was adequate. Conclusion EMR onboarding education for medical users is a critical ingredient to organizational safety and efficiency. An improvement in satisfaction ratings by junior doctors was demonstrated after significant re-design of the curriculum was informed and delivered by peers, in line with adult learning principles.

scholarly journals United Kingdom Diabetic Retinopathy Electronic Medical Record (UK DR EMR) Users Group: report 4, real-world data on the impact of deprivation on the presentation of diabetic eye disease at hospital services

2018 ◽  
Vol 103 (6) ◽  
pp. 837-843 ◽  
Author(s):  
Alastair K Denniston ◽  
Aaron Y Lee ◽  
Cecilia S Lee ◽  
David P Crabb ◽  
Clare Bailey ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Diabetic Retinopathy ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Real World ◽  
Eye Disease ◽  
Inclusion Criteria ◽  
Data Set ◽  
Diabetic Eye Disease ◽  
The Impact

AimTo assess the impact of deprivation on diabetic retinopathy presentation and related treatment interventions, as observed within the UK hospital eye service.MethodsThis is a multicentre, national diabetic retinopathy database study with anonymised data extraction across 22 centres from an electronic medical record system. The following were the inclusion criteria: all patients with diabetes and a recorded, structured diabetic retinopathy grade. The minimum data set included, for baseline, age and Index of Multiple Deprivation, based on residential postcode; and for all time points, visual acuity, ETDRS grading of retinopathy and maculopathy, and interventions (laser, intravitreal therapies and surgery). The main  outcome measures were (1) visual acuity and binocular visual state, and (2) presence of sight-threatening complications and need for early treatment.Results79 775 patients met the inclusion criteria. Deprivation was associated with later presentation in patients with diabetic eye disease: the OR of being sight-impaired at entry into the hospital eye service (defined as 6/18 to better than 3/60 in the better seeing eye) was 1.29 (95% CI 1.20 to 1.39) for the most deprived decile vs 0.77 (95% CI 0.70 to 0.86) for the least deprived decile; the OR for being severely sight-impaired (3/60 or worse in the better seeing eye) was 1.17 (95% CI 0.90 to 1.55) for the most deprived decile vs 0.88 (95% CI 0.61 to 1.27) for the least deprived decile (reference=fifth decile in all cases). There is also variation in sight-threatening complications at presentation and treatment undertaken: the least deprived deciles had lower chance of having a tractional retinal detachment (OR=0.48 and 0.58 for deciles 9 and 10, 95% CI 0.24 to 0.90 and 0.29 to 1.09, respectively); in terms of accessing treatment, the rate of having a vitrectomy was lowest in the most deprived cohort (OR=0.34, 95% CI 0.19 to 0.58).ConclusionsThis large real-world study suggests that first presentation at a hospital eye clinic with visual loss or sight-threatening diabetic eye disease is associated with deprivation. These initial hospital visits represent the first opportunities to receive treatment and to formally engage with support services. Such patients are more likely to be sight-impaired or severely sight-impaired at presentation, and may need additional resources to engage with the hospital eye services over complex treatment schedules.

An Objective Study of the Impact of the Electronic Medical Record on Outcomes in Trauma Patients

2012 ◽  
Vol 78 (11) ◽  
pp. 1249-1254 ◽  
Author(s):  
Paul J. Schenarts ◽  
Claudia E. Goettler ◽  
Michael A. White ◽  
Brett H. Waibel
Keyword(s):  
Length Of Stay ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Injury Severity ◽  
Unit Length ◽  
Traumatic Injury ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Delay In Diagnosis ◽  
The Impact

It is commonly believed that the electronic medical record (EMR) will improve patient outcomes. However, there is scant published literature to support this claim and no studies in any surgical population. Our hypothesis was that the EMR would not improve objective outcome measures in patients with traumatic injury. Prospectively collected data from our university-based Level I trauma center was retrospectively reviewed. Demographic, injury severity as well as outcomes and complications data were compared for all patients admitted over a 20-month period before introduction of the EMR and a 20-month period after full, hospital-wide use of the EMR. Implementation of the EMR was associated with a decreased hospital length of stay, P = 0.02; intensive care unit length of stay, P = 0.001; ventilator days, P = 0.002; acute respiratory distress syndrome, P = 0.006, pneumonia, P = 0.008; myocardial infarction, P = 0.001; line infection, P = 0.03; septicemia, P = 0.000; renal failure, P = 0.000; drug complication, P = 0.001; and delay in diagnosis, P = 0.04. There was no difference in mortality, unexpected cardiac arrest, missed injury, pulmonary embolism/deep vein thrombosis, or late urinary tract infection. This is the first study to investigate the impact of the EMR in surgical patients. Although there was an improvement in some complications, the overall impact was inconsistent.

scholarly journals P105: Observational study of distribution of time and activities over the course of an emergency physician's shift

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S102-S103
Author(s):  
E. Feng ◽  
Z. Zia ◽  
C. Tong ◽  
N. Cornell
Keyword(s):  
Medical Information ◽  
Patient Flow ◽  
Second Phase ◽  
Time Motion ◽  
Patient Interaction ◽  
Physician Productivity ◽  
Motion Study ◽  
One Year ◽  
The Impact ◽  
Insight Into

Introduction: The growing scrutiny to improve Emergency Department (ED) wait times and patient flow have resulted in many efforts to increase efficiency and maximize patient throughput via systems improvements. This study investigates areas of efficiency improvement from the Emergency Physician (EP) perspective by examining EP workflow in a two phased observational time-motion study. In the initial phase, the distribution of time and activities of EPs were dissected to identify potential sources for streamlining to maximize physician productivity. The first phase was of the study was completed during the period immediately preceding the implementation of an Electronic Health Records (EHR). The second phase of the study will repeat the analysis one year post EHR implementation. This data will be dissected to again identify sources for streamlining in an EHR environment and to identify shifts in work flow from a paper-based system. Methods: An observational time motion study was conducted at St. Mary's Hospital ED, in Kitchener Ontario. An observer was paired with an EP for the duration of an 8 hour shift, to a total of 14 shifts in the first phase of the study. Nine task categories were measured concurrently with a stopwatch application on a tablet, along with the number of interruptions experienced by the EP. Means of each category were calculated and converted to percentages, representing the amount of time per 8 hour shift dedicated to each activity. The second phase will be repeated in Fall 2020, 1 year after EHR implementation. Results: A total of 14 shifts were observed, accounting for 112 hours of observation. EP's time was allocated amongst the following categories: direct patient interaction (40.8%), documentation (27.1%), reviewing patient results (18.4%), communicating with ED staff (7.63%), personal activities (5.7%), writing orders (5.1%), communicating with consultants (3.3%), teaching (1.7%) and medical information searches (1.3%). On average, EPs experienced 15.8 interruptions over the course of an 8 hour shift. Conclusion: In a paper charting system, the direct patient interaction accounts for the largest timeshare over the course of a given shift. However, the next two largest categories, documentation and reviewing patient data, both represent areas of potential streamlining via clerical improvements. Additionally, detailed measurements of EPs’ activities have proven feasible and provides the potential for future insight into the impact of EHR's on EP workflow.

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