M. B. Gyimah1,2, S. Peiffer1,2, T. C. Lee1,2, S. Keswani1,2, A. King1,2 1Texas Children’s Hospital, Pediatric Surgery, Houston, TX, USA 2Baylor College Of Medicine, Houston, TX, USA
Introduction: As an electronic version of the patient medical history, the electronic medical record (EMR) is maintained by providers and serves as a record of clinical data relevant to patient care. EMR also serves as a communication tool between patients, referring providers and consultants with delineation of key findings, radiology reports and plans. Timely and accurate documentation is paramount. We developed standardized templates for EMR (EMR-temp) in the surgical care of ambulatory prenatal consultation of surgical fetal anomalies (SFA) and aim to evaluate the impact of EMR-temp in provider documentation practices in prenatal care of SFA.
Methods: We retrospectively reviewed all prenatal consultations of SFAs seen at a tertiary care children’s hospital with a large volume fetal center (2019-2022). Standardized templates were developed for congenital diaphragmatic hernia (CDH), congenital lung malformation (CLM), neural tube defects (NTD), gastroschisis, heterotaxy, and bowel obstruction. Provider, final diagnosis, and components of EMR including time of appointment, use of EMR-temp and final time of completion of the encounter by provider were recorded. Time to completion (TTC) was calculated from electronic opening of encounter to closure by provider. Descriptive statistics and Wilcoxson rank sum tests were used.
Results: 726 prenatal consultations were identified with 5 providers, with 133 consultations (18.3%) using a disease-specific EMR-temp. 54 (40.7%) were CDH, 51 (38.3%) were CLM, 9 (6.8%) NTD, 8 (6.0%) gastroschisis, 9 (6.8%) were heterotaxy, and 2 (1.5%) were for bowel obstruction. The overall median TTC was 23.7 hours [IQR 126.4]. EMR-temp use decreased TTC; in encounters without EMR-temp use, TTC was 28.4 hours [IQR 157.9] compared with EMR-temp use 2.07 hours [IQR 75.4] (p<0.001). The impact of EMR-temp varied across disease processes. In CDH, overall TTC was 42.6 hours [137.6]. We observe a 34% decrease in TTC compared with use of EMR-temp (TTC: non-EMR-temp 64.4 hours [171.7] vs EMR-temp 19.7 hours [IQR 54.7]). In NTD, overall TTC was 45.1 hours [IQR 92.5] with a decrease in documentation time of 97.8% (TTC: non-EMR-temp 47.9 [IQR 139.9] vs EMR-temp 1.02 [IQR 1.05]). Improvement in TTC was not universal across disease processes, with no difference in TTC with use of EMR-temp in CLM (TTC: non-EMR-temp 21.7 hours vs EMR-temp 1.3, p=0.17), gastroschisis (TTC: non-EMR-temp 37.2 hours versus EMR-temp 49.2, p=0.33) and heterotaxy (TTC: non-EMR-temp 18.2 hours vs 21.2 hours, p=0.72).
Conclusion: We find implementation of a standardized template in prenatal consultation of SFA decreases the time required to document clinical encounters as compared to its non-use. A standardized template can be an impactful tool to streamline provider workflow. The impact of the template was varied across disease processes which suggests other factors impact completion of documentation and warrant further investigation.