Our institution has been challenged with the time it takes to complete the electronic version of the admission history power form, a vital documentation component of the patient’s episode of care. The process prior to a recent optimization effort required the nurse to use multiple clicks, document duplicate data, and take a significant amount of time away from the patient to complete the admission history documentation component. Like most healthcare organizations, there were many attempts to reduce documentation burden which unfortunately resulted in no value add or reduction of time.
In 2021, post the height of the pandemic, our organization targeted the reduction of documentation burden in the acute areas as a strategic imperative. The discovery process was initiated. As part of our discovery, we partnered with our EHR vendor who had previously engaged in a multisystem collaboration effort to reduce the burden of nursing documentation during the inpatient admission process. The cohort utilized a three-step process for review and evaluation of each DTA and determine gaps among themselves. 1) Are each of the data elements essential? 2) Which data elements are explicitly required during the admission process? 3) Is a credentialed nurse (RN) required to document the specific data elements?
In addition to the evaluation of the data elements process, each of the cohorts completed time studies to baseline the average time the nurse took to complete the admission history process. Additional thoughts contributed to evaluating the frequency of adding more documentation elements to the admission history component. The downfall to adding more data elements is the lack of processes to evaluate the admission history component for duplication or removal of non-essential elements, which may cause noise. As a result of the twelve-organization collaboration and evaluation of each of their admission history processes, they had a significant reduction of documentation elements as well as the time it took to complete the admission history process.
This became a priority for our organization to replicate the work of the twelve-organization cohort. We worked closely with our EHR vendor strategist and consulting team over the course of six months, utilizing a monthly interdisciplinary clinical practice group of 24 nurses for 4 hours per month plus the clinical informatics and technical team. This meeting reviewed the current-to-future state of the project, and similarly to the above twelve cohort, reviewed all data elements on the admission history form utilizing the above three questions for all inpatient units, except the NICU, which will be evaluated later.
In replicating the process of the vendor new model recommendations, our initial implementation yielded the following: 1) 32% decrease in the number of data elements, 2) 52% decrease in clicks to complete admission history form, and 3) 40% decrease in average time to complete the admission history form, which is on track to yield a significant annual savings in hours.
After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Clinical Informatics Specialist,
Children's Hospital of Orange County