01.23 The Lasting Effects of COVID-19 on the Efficiency of Vascular Surgery Interns’ EMR Usage

E. Lavanga1, A. Zil-E-Ali2, K. Krause1, C. DeHaven1, F. Aziz2  1Penn State College of Medicine, Division Of Vascular Surgery, Hershey, PA, USA 2Penn State Health Hershey Medical Center Heart and Vascular Institute, Division Of Vascular Surgery, Hershey, PA, USA

Introduction: The COVID-19 pandemic altered workflow in hospitals across the United States, requiring vascular surgery resident physicians to adapt their patient care strategies and improve their electronic medical record (EMR) efficiency. The aim of this study was to examine the impact of the pandemic-necessitated changes in surgery program workflow on EMR usage of vascular surgery residents across multiple years of training. 

Methods: Vascular surgery resident EMR usage data was obtained from the Cerner © Advance User Experience from March 2019 to May 2021. Surgical caseloads for each post-graduate year (PGY) were obtained from hospital records. Usage time was tracked from user login to logout. The data was divided into three timepoints: before, during, and after COVID-necessitated workflow alterations and was subdivided into usage categories including total time, chart review, documentation, electronic orders, and messaging time. EMR usage by timepoint, EMR usage by PGY, and EMR usage by both timepoint and PGY were analyzed via Kruskal-Wallis test with significance set at 0.05. 

Results: EMR data from seven residents was included in the study across three timepoints. All day average EMR use decreased from 115.56 ± 97.3 to 89.54 ± 78.6 minutes during COVID workflow disturbances and remained low at 93.56 ± 82.3 minutes following the reinstitution of normal workflow (p-value <0.001). This permanent decline in both daytime and evening EMR usage following workflow alterations was observed for total time, chart review time, and order placement. All day EMR usage decreased with increasing PGY. The most significant decrease was observed from PGY three with an average of 102.28 ± 78.0 minutes per day to PGY four with an average of 56.29 ± 45.5 minutes per day demonstrating a 46-minute decrease in EMR time (p-value <0.001). Analysis of PGY EMR use across the three timepoints demonstrated that PGY one residents were the most influential in the decrease in EMR use following COVID-related workflow changes. Intern EMR usage declined from 204.9 ± 112.1 minutes to 121.10 ± 92.3 and then stabilized at 128.82 ± 125.7 minutes following resolution of normal workflow (p-value <0.001). Surgeries decreased by approximately 22 cases during COVID-19 restrictions.

Conclusion: Vascular surgery interns demonstrated the most significant permanent improvement in EMR efficiency during the COVID-19 pandemic alterations to hospital workflow. The novice status of intern training allowed PGY one residents to easily adapt to the changes in surgical program workflow and optimize the efficiency of their EMR usage to prioritize in person patient care.