From Paperwork To Patient Care

System Yields Efficiencies, Clinical Improvements

Prior to automating medical records, nursing staff spent an average of five hours per 12-hour shift on manual charting and paperwork, says Putnam. Within the first week of using the system, that time was reduced to 20 minutes per nurse per shift. The system has also shaved off two hours of record-keeping time each day for dietary and social services staff and one hour each day for therapists. In addition, nursing and therapy staff no longer spend a combined 25 hours of overtime preparing end of the month reports.

As a result, nurses are able to spend vastly more time with patients – a change that showed up immediately in patient outcomes, Putnam says. As Three Rivers is a restraint-free facility, falls were a constant focus for quality improvement. Within I the first month of using the EMR system, falls at the facility decreased by 40 percent. Initially, it wasn’t clear whether the dramatic decline was a one time event or the start of a trend, says Putnam.

However, the 40 percent reduction continued to hold month after month, and Putnam attributes the improvement to a simple equation: “When nurses are on the floor instead of behind the nurses’ desk and are doing more patient care, it increases the quality of care.” Quality indicator reports also show that the facility has improved in the areas of pressure ulcers and weight loss, she adds.

User-Friendly

While some staff resisted the transition to an electronic system, most have seen the shift from paperwork to patient care as a significant plus, says Putnam. Nurses received four hours of preparatory training, and when the program was launched, one system expert was available on each unit during the first week to help nursing staff with entries. For the most part, however, staff worked independently after the first couple of days, says Putnam.

“The basic nursing note entry can be learned in an hour, including learning the password,” Putnam says. Though Three Rivers doesn’t us agency staff, the system is simple enough to provide training for personnel who come in on an intermittent basis, she adds. Preparing physician orders, which is more difficult than nursing entries, did require follow-up training.

The facility’s orientation program now includes computer training instead of an introduction to the 150 various forms that were once part of medical record keeping. In addition to easing the documentation burden on its own staff, Three Rivers’ EMR system gets high marks from other providers, Putnam says. Physicians appreciate quick access to up-to-date patient information, and hospitals appreciate not having to struggle to read handwritten nursing notes.

Three Rivers’ cost for the EMR system, which includes computer hardware, antennas for the wireless system, and software, was more than $60,000. Under Ohio reimbursement rules, those costs will be paid back as capital costs, depreciated over five years, says McKinley. The facility will likely recoup much of its investment sooner, however, through reduced staff costs, McKinley says. The facility has so far eliminated two full-time secretarial positions and 1.5 positions in the medical records department.

“The end result is worth the effort,” says Putnam, who predicts that over time, the EMR systems will proliferate in long term care settings. “They will catch on slowly, but they will catch on because they have too many benefits” to overlook, she says.