title: Time-motion analysis of clinical nursing documentation during implementation of an electronic operating room management system for ophthalmic surgery.
abstract: Efficiency and quality of documentation are critical in surgical settings because operating rooms are a major source of revenue, and because adverse events may have enormous consequences. Electronic health records (EHRs) have potential to impact surgical volume, quality, and documentation time. Ophthalmology is an ideal domain to examine these issues because procedures are high-throughput and demand efficient documentation. This time-motion study examines nursing documentation during implementation of an EHR operating room management system in an ophthalmology department. Key findings are: (1) EHR nursing documentation time was significantly worse during early implementation, but improved to a level near but slightly worse than paper baseline, (2) Mean documentation time varied significantly among nurses during early implementation, and (3) There was no decrease in operating room turnover time or surgical volume after implementation. These findings have important implications for ambulatory surgery departments planning EHR implementation, and for research in system design.
authors.affiliation: Departments of Ophthalmology, Preventive Medicine Oregon Health & Science University, Portland, OR.
authors.forename: Sarah
authors.initials: S
authors.lastname: Read-Brown
authors.affiliation: Departments of Ophthalmology, Preventive Medicine Oregon Health & Science University, Portland, OR.
authors.forename: David S
authors.initials: DS
authors.lastname: Sanders
authors.affiliation: Departments of Ophthalmology, Preventive Medicine Oregon Health & Science University, Portland, OR.
authors.forename: Anna S
authors.initials: AS
authors.lastname: Brown
authors.affiliation: Medical Informatics & Clinical Epidemiology, Preventive Medicine Oregon Health & Science University, Portland, OR.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Yackel
authors.affiliation: Public Health & Preventive Medicine Oregon Health & Science University, Portland, OR.
authors.forename: Dongseok
authors.initials: D
authors.lastname: Choi
authors.affiliation: Departments of Ophthalmology, Preventive Medicine Oregon Health & Science University, Portland, OR.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Tu
authors.affiliation: Departments of Ophthalmology, Preventive Medicine Oregon Health & Science University, Portland, OR ; Medical Informatics & Clinical Epidemiology, Preventive Medicine Oregon Health & Science University, Portland, OR.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Chiang
mesh_terms: D004282:Documentation; D057286:Electronic Health Records; D016347:Medical Records Systems, Computerized; D009737:Nursing Records; D009870:Operating Room Information Systems / Q000458:organization & administration*; D009873:Operating Rooms / Q000458:organization & administration; D013508:Ophthalmologic Surgical Procedures; D013996:Time and Motion Studies