The pediatric transport team implemented electronic documentation to improve the safety, efficiency, timeliness, and quality of healthcare and promote interoperability of patient records. This new product allows transport team members to document based on patient conditions and customize documentation fields as needed. The electronic medium also gives the team members access to evidence-based guidelines and recommendations from other resources. In addition, this product integration receives real-time information and transport updates, then pushes all the data into the hospital's electronic health record (EHR).
Problem: Documentation on paper during the transfer of patients did not provide the dynamics to cover documentation for each type of transport and situation during the transport. Paper-based documentation lacked data and analytic capabilities and needed improved legibility and documentation completion rates.
Methodology: The project team went through several case-scenarios throughout the testing and user acceptance testing stages of the systems development life cycle (SDLC), focused on application, integrating, and user testing prior to implementation. Ideas for change included interviews and observations of stakeholders’ current workflows, obtaining stakeholders’ input and ideas for successful completion of the project and cause-and-effect diagrams to show improvements. Leveraging relationships with other transport agencies played a role in consideration of how to use the new product. The project started with the planning and designing of the new workflows and was followed by training, system development and design, end-user training, implementation, and ongoing education. The project team analyzed the current state/measures versus the future state of percentages of documentation completion on the forms, as well as illegibility. The system usability scale (SUS) survey was used to evaluate the customer's usability and perceived satisfaction of the new product pre- and post-implementation by 26 participants. The SUS surveys were scored using Jeff Sauro's (2011) online scoring guidelines as a reference from the usability.gov website.
Results: The legibility and form completion percentages had significant improvements from pre-implementation to post-implementation. The illegibility of transport records improved from 24% pre-implementation to 100% post-implementation; the incomplete forms documentation rate improved from 56% pre-implementation to 100% post-implementation. The SUS score means improved from 67.6 pre-implementation to 82.3 post-implementation. According to the United States General Services Administration (2020), SUS scores above 68 are considered above average; the transport team recognized their post-implementation score to be 14.3 points higher.
Conclusion: Not only does paper charting restrict ease of access, but it can also be illegible, incomplete, and easily lost or misplaced. This project continues to improve the quality of documentation, quality of care, and safety for patients. Having fully implemented phase II of the project, the project team members will soon start phase III, and continue to collect data to prove the project's success.