A. M. Jensen1, P. Pieper2, M. S. Nussbaum1, C. L. Leaphart1 1University Of Florida,Department Of Surgery,Jacksonville, FL, USA 2University Of Florida,College Of Nursing,Jacksonville, FL, USA
Introduction: The electronic health record and limits on resident work hours have altered patterns of communication between physicians and nurses. Effective handoffs between interdisciplinary teams and for teams transitioning from day to overnight call are important safety initiatives promoting quality patient care. Anecdotal evidence suggests that communication is adversely affected by using electronic health records thereby potentially decreasing quality of patient care. To assess the effects of the EHR and limited duty hours on communication patterns and handoffs, we measured paging volume and nature of calls for on-call interns in pre- and post-implementation periods of the EHR.
Methods: After IRB approval, a data dictionary was created to standardize categories of on-call pages to interns. A College of Nursing faculty member, blinded to the purposes of the study, categorized the data dictionary into emergent or non-emergent needs. For on-call interns in General Surgery, a check sheet was created from the data dictionary and reviewed prior to implementation during overnight calls from 5 PM – 6 AM. Volume of pages to on call interns was collated by hour and call type for an 8-week period (May –June 2015). The data dictionary was used to compare call volume and type in a pre- and post-implementation period of the EHR.
Results: Prior to implementation of the EHR, the most common reasons for intern pages were for order clarification (32%, n=82) and pain management (19%, n=50). Highest call volume occurred between 8 PM -2 AM with only 19% of pages (50/260) determined to be for emergent needs. Strikingly, after EHR implementation, Pareto analysis determined the highest reasons for call to be consult-related pages (29%,n=178), pain management (12%, n=74), and abnormal labs/test results/vital signs (12%, n=73), indicating that standardized order sets potentially decrease the need for order clarification. Highest call volume post-EHR implementation occurred between 8 PM – 2 AM with 71% of pages determined as emergent. Consistency of times for high volume paging in the pre- and post-EHR periods was determined to be related to hospital throughput and patient flow from the emergency department and operating room to the surgical floors.
Conclusion: Although limited duty hours and EHR implementation may alter communication patterns between nurses and physicians, standardization of orders may improve clarity of patient needs and quality of care being provided. Future efforts in improving delivery of care may focus on improved order sets with attention to specific patient needs.