title: The impact of an electronic health record on nurse sensitive patient outcomes: an interrupted time series analysis.
abstract: OBJECTIVE
  To evaluate the impact of electronic health record (EHR) implementation on nursing care processes and outcomes.
  
  
  METHODS
  Interrupted time series analysis, 2003-2009.
  
  
  METHODS
  A large US not-for-profit integrated health care organization.
  
  
  METHODS
  29 hospitals in Northern and Southern California.
  
  
  METHODS
  An integrated EHR including computerized physician order entry, nursing documentation, risk assessment tools, and documentation tools.
  
  
  METHODS
  Percentage of patients with completed risk assessments for hospital acquired pressure ulcers (HAPUs) and falls (process measures) and rates of HAPU and falls (outcome measures).
  
  
  RESULTS
  EHR implementation was significantly associated with an increase in documentation rates for HAPU risk (coefficient 2.21, 95% CI 0.67 to 3.75); the increase for fall risk was not statistically significant (0.36; -3.58 to 4.30). EHR implementation was associated with a 13% decrease in HAPU rates (coefficient -0.76, 95% CI -1.37 to -0.16) but no decrease in fall rates (-0.091; -0.29 to 0.11). Irrespective of EHR implementation, HAPU rates decreased significantly over time (-0.16; -0.20 to -0.13), while fall rates did not (0.0052; -0.01 to 0.02). Hospital region was a significant predictor of variation for both HAPU (0.72; 0.30 to 1.14) and fall rates (0.57; 0.41 to 0.72).
  
  
  CONCLUSIONS
  The introduction of an integrated EHR was associated with a reduction in the number of HAPUs but not in patient fall rates. Other factors, such as changes over time and hospital region, were also associated with variation in outcomes. The findings suggest that EHR impact on nursing care processes and outcomes is dependent on a number of factors that should be further explored.
authors.affiliation: School of Healthcare, University of Leeds, Leeds, UK. d.dowding@leeds.ac.uk
authors.forename: Dawn W
authors.initials: DW
authors.lastname: Dowding
authors.forename: Marianne
authors.initials: M
authors.lastname: Turley
authors.forename: Terhilda
authors.initials: T
authors.lastname: Garrido
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D000368:Aged; D002140:California; D057286:Electronic Health Records; D005260:Female; D006751:Hospital Information Systems; D006801:Humans; D008297:Male; D008875:Middle Aged; D009096:Multi-Institutional Systems; D015999:Multivariate Analysis; D009732:Nursing Care; D010043:Outcome and Process Assessment, Health Care; D003668:Pressure Ulcer / Q000517:prevention & control; D012044:Regression Analysis; D018570:Risk Assessment; D018511:Systems Integration