Nursing documentation burden reduction has been a focus at our institution as we look for ways to increase staff satisfaction and retention. As we explored ways to reduce nursing documentation burden, we received feedback from our shared governance committee that our currently non-interfaced point-of-care testing represented an additional burden of tasks and time for ambulatory nurses.
At our large academic medical center, comprised of over 150 ambulatory care clinic locations, point-of-care testing volumes have risen in the last few years, both due to COVID-19 point-of-care tests and the increasing daily patient volume that these clinics accommodate. Our team conducted some observations in clinics that performed differing volumes of POC tests run on different machines such as urinalysis and flu tests. During our observations, it was noted that some parts of the point-of-care process were so burdensome that nurses would complete the “essential” steps in order to have the results available for the patient and save the “non-essential” steps of uploading the paper document for scanning for a non-peak time in clinic. This resulted in the document not being accessible, sometimes for days. The paper document must be retained for compliance/auditing purposes when the machines are not interfaced with the EHR.
We also noted during our observations that in some clinics with high point-of-care volumes, one nurse was dedicated to processing point-of-care tests and inputting the results into the EHR. Often, that nurse had to be pulled out of staffing, due to the high volume of point-of-care tests. After completing a workflow analysis and identifying the basic steps of point-of-care testing, we conducted a time study to quantify the amount of time we could save nurses by building an interface for point-of-care machines to bi-directionally communicate with our EHR.
In addition to reducing documentation burden, creating an interface would also improve accuracy of these results. A 2020 study found that manually entered test results had a 9% error rate, which can impact patient treatment plans (Young et al., 2020).
The results of our time study indicated that several steps of the point-of-care process could be eliminated by having an interface between the devices and the EHR. We determined that we could save an average of 115 seconds per test if point-of-care test results were automatically available in the patient’s chart. After reviewing point-of-care test volumes in clinics that had non-interfaced devices, we determined that those areas completed, on average, 6500 tests per month. Saving approximately 115 seconds per test would mean that, across the enterprise, we could save over 200 nursing hours per month by implementing a point-of-care interface with the EHR.
Reference: Young, P. E., Diaz, G. J., Kalariya, R. N., Mann, P. A., Benbrook, M. N., Avandsalehi, K. R., et al. (2020). Comparison of the time required for manual (visually read) and semi-automated POCT urinalysis and pregnancy testing with associated electronic medical record (EMR) transcription errors (Article). Clinica Chimica Acta, 504, 60-63. doi:10.1016/j.cca.2020.01.021
