More Efficient Charting — On the Medical-Surgical Floor

Efficient Charting and Documentation on the Medical-Surgical Floor

Now more than ever patient care on the modern medical-surgical floor can be complex.4 You work hard to carefully document your patients’ conditions in real time while managing priorities.5 In fact, charting is one of your most time-consuming tasks — requiring up to 35.3 percent of each shift.1

That’s the reason so many clinicians like you are innovating charting — to prioritize time with patients. Now you can sync monitoring data with electronic medical record (EMR) systems.6 That helps provide access to patient charts quickly through mobile devices like tablets.7 With the help of better charting technology, you can spend less time at a computer, reduce errors, and improve patient care.6

Your hospital could benefit from a treatment plan based on sound charting science. Consider the ways you can recoup time and improve outcomes through smarter workflow and better charting technologies.

BETTER CHARTING CHECKLIST

1. WASTE LESS TIME ON THE MEDICAL-SURGICAL FLOOR

For every hour spent on patient care per shift, nurses can spend 30 minutes to an hour on paperwork.8 In one large hospital survey, doctors and nurses rated paper-based documentation as the activity that was most time-consuming.9 It was considered more wasteful than 17 other causes, including nosocomial infections and transferring between wards and the restroom.9

Also, clinicians must remember and periodically refresh up to 20 passwords — spending crucial time continuously navigating these security measures.10 Hospital staff takes an average of 29.3 seconds every time they need to reconnect to patient EHRs.11

TECH-SAVVY TREATMENT PLAN

Single sign on technology can reduce re-login time by 69 percent.11 Across six hospitals, single sign on saved 2,256 clinicians 1,461 hours — equal to 122 shifts — per facility, each year.10   It also saved $92,146 in annual financial returns for each facility.10

Integrating monitoring devices with EMR systems can also help by transmitting patient data automatically.8 Syncing monitoring data with EMRs may save up to 30 minutes per day and help improve patient outcomes by reducing falls.8 Yet, the vast majority of hospitals use medical devices that don’t integrate with each other or with patient EMRs.12

Related: Remote monitoring may help you sync patient data automatically and save time. Learn more.

2. USE WIRELESS SOLUTIONS TO REDUCE CHARTING ERRORS

Record keeping by hand is not only inefficient but can also introduce transcription errors to patient data or lead to incomplete records.13

One hospital found that transcription errors occurred 53 percent of the time, and prescribing errors 37 percent of the time.14 The same study revealed bad handwriting happened in 52 percent of cases and 4 percent of the time it was unreadable.14

While EMR systems allow for some improvements, both manual and electronic data entry on EMRs may lead to confusion or errors while recording patient information.15 One study at a metropolitan hospital showed medication errors in 12.1 percent of handwritten and 13.3 percent of electronic discharge summaries.15

TECH-SAVVY TREATMENT PLAN

Documenting with mobile devices can help reduce charting discrepancies and errors — from 14.4 percent to 4.4 percent according to one study.16 Mobile devices can increase the accuracy of diagnostic coding and the recording of neonatal patient weight in intensive care.17 And electronic templates have shown they can improve the recording of patient prescription information.18

It’s also possible to embed machine learning technology into EMR systems with the aim of alerting clinicians when orders have errors or omissions.18

Fewer errors can mean better patient outcomes. In one study, physicians who used mobile devices with built in clinical decision support systems prescribed antibiotics at a lower rate — and reduced hospital stays.17

Related: Wireless solutions may help reduce charting errors.  See how.

3. SPEND MORE FACE-TIME WITH PATIENTS BY REDUCING DOCUMENTATION TIME

Direct care can determine better patient outcomes, decrease errors, and improve the satisfaction of patients, nurses, and clinicians.3

And yet much of a nurse’s time is spent outside patients’ rooms.1 That’s because charting and coordinating care can take up to 56 percent of one nursing shift.1 In a time-motion study, busy medical-surgical nurses spent only 2.8 percent of documentation time in patients’ rooms, compared with 80.6 percent at the nurses’ station.1

Even while inside the patient’s room, charting may take time away from bedside care — or at least divide a nurse’s attention.5 For example, nurses may turn away from the patient to update a chart on a wall-mounted EMR system.5 This could interfere with communication by causing the nurse to miss information.5 It may also make the patient feel ignored. Especially if the nurse’s phone rings multiple times during a patient interaction — which interrupts a nurse 16 percent of the time in a patient room.5

TECH-SAVVY TREATMENT PLAN

Using a mobile device to store EMRs can help physicians reduce the time spent on hospital rounds, charting, and looking up medical data.7 As a result, physicians can spend up to 1.4 minutes more at each patient's bedside.7

Also, portable handheld devices have been shown to help with clinical decision support.17 One hospital introduced portable devices. Shortly after, adherence rates for the prophylactic use of aspirin in patients at risk for coronary artery disease rose from 33 percent to 81 percent.17 Screenings for colorectal disease, cervical cancer, and cholesterol also rose significantly.17 One study found that portable devices increase the quality of data collection and improve the appropriateness of diagnosis and treatment decisions.19

Related: See where direct time with patients can get lost on the medical-surgical floor. View the infographic.

References:
1. Hendrich A, Chow MP, Skierczynski BA, Lu Z. A 36-hospital time and motion study: how do medical-surgical nurses spend their time? Perm J. 2008;12(3):25–34.
2. Alotaibi YK, Federico F. The impact of health information technology on patient safety. Saudi Med J. 2017;38(12):1173–1180.
3. Westbrook JI, Duffield C, Li L, Creswick NJ. How much time do nurses have for patients? A longitudinal study quantifying hospital nurses’ patterns of task time distribution and interactions with health professionals. BMC Health Serv Res. 2011; 11:319. doi: 10.1186/1472-6963-11-319.
4. Gordon JE, Deland E, Kelly RE. Let’s talk about improving communication in healthcare. Col Med Rev. 2015; 1(1):23-27. doi: 10.7916/D8RF5T5D.
5. Yen PY, Kellye M, Lopetegui M, et al. Nurses' Time Allocation and Multitasking of Nursing Activities: A Time Motion Study. AMIA Annu Symp Proc. 2018;2018:1137–1146.
6. Fieler VK, Jaglowski T, Richards K. Eliminating errors in vital signs documentation. Comput Inform Nurs. 2013;31(9):422–7; quiz 428–429. doi: 10.1097/01.NCN.0000432125.61526.27.
7. Fleischmann R, Duhm J, Hupperts H, Brandt SA. Tablet computers with mobile electronic medical records enhance clinical routine and promote bedside time: a controlled prospective crossover study. J Neurol. 2015;262(3):532–540. 
8. Turisco F, Rhoads J. Equipped for efficiency: Improving nursing care through technology. 2008: California HealthCare Foundation Website. https://www.chcf.org/wp-content/uploads/2017/12/PDF-EquippedForEfficiency.pdf. Published Dec. 2008.
9. Bagheri Lankarani K, Ghahramani S, Roozitalab M, Zakeri M, Honarvar B, Kasraei H. What do hospital doctors and nurses think wastes their time? SAGE Open Med. 2019;7:2050312118813680. doi: 10.1177/2050312118813680.
10. Gellert GA, Crouch JF, Gibson LA, Conklin GS, Webster SL, Gillean JA. Clinical impact and value of workstation single sign-on. Int J Med Inform. 2017;101:131–136.
11. Drees J. How single sign-on within EHRs can save clinicians time, reduce hospital costs & improve patient care. Becker’s Hospital Review Website. https://www.beckershospitalreview.com/healthcare-information-technology/how-single-sign-on-within-ehrs-can-save-clinicians-time-reduce-hospital-costs-improve-patient-care.html. Published May 7, 2019. Accessed June 15, 2019.
12. De Georgia MA, Kaffashi F, Jacono FJ, Loparo KA. Information technology in critical care: review of monitoring and data acquisition systems for patient care and research. ScientificWorldJournal. 2015;2015:727694.
13. Clarke B. The Cost of Manual Charting. Point Care. 2013;12(2):67–68.
14. Hartel MJ, Staub LP, Röder C, Eggli S. High incidence of medication documentation errors in a Swiss university hospital due to the handwritten prescription process. BMC Health Serv Res. 2011;11:199. doi: 10.1155/2015/727694.
15. Callen J, McIntosh J, Li J. Accuracy of medication documentation in hospital discharge summaries: A retrospective analysis of medication transcription errors in manual and electronic discharge summaries. Int J Med Inform. 2010;79(1):58–64.
16. Prgomet M, Georgiou A, Westbrook JI. The impact of mobile handheld technology on hospital physicians' work practices and patient care: a systematic review. J Am Med Inform Assoc. 2009;16(6):792–801.
17. Mickan S, Atherton H, Roberts NW, Heneghan C, Tilson JK. Use of handheld computers in clinical practice: a systematic review. BMC Med Inform Decis Mak. 2014;14:56. doi: 10.1186/1472-6947-14-56.
18. Lorenzetti DL, Quan H, Lucyk K, et al. Strategies for improving physician documentation in the emergency department: a systematic review. BMC Emerg Med. 2018;18(1):36. doi: 10.1186/s12873-018-0188-z.
19. Divall P, Camosso-Stefinovic J, Baker R. The use of personal digital assistants in clinical decision making by health care professionals: a systematic review. Health Informatics J. 2013;19(1):16–28.

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TOPIC: Microstream™ Capnography MonitoringMedical-Surgical

About the Author

Melissa Worthington

Melissa Worthington is a clinical product specialist at Medtronic specializing in Microstream™ capnography, Nellcor™ pulse oximetry, and Vital Sync™ Remote Monitoring systems. She was previously an adult cardiac/labor and delivery RN in Columbus, Ohio, and a keynote speaker at Respiratory Therapy Symposiums in Dayton, Ohio.

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