Bedside caregivers provide most direct care for patients, from monitoring and continuity – no one seems to argue with that assertion. Still most electronic health records (EHRs) focus primarily on the combination of organizational performance and doctor-related costs of care, clinical decision efficacy, error reduction and documentation. What bedside caregivers do and need is often an afterthought.

The healthcare industry needs the powerful impact of EHRs that help bedside clinicians more.  EHRs need to enhance bedside caregivers with intelligence-driven capabilities. Five healthcare organizations rigorously undertook six studies of how Allscripts SunriseTM affects bedside caregivers with nurses as the focal point – primarily both as the mainstays of the bedside presence, as well as proxy perspectives for the team of bedside non-physician caregivers.

What was found, and published in peer-review*, adds enormous substance to the favorability of best-EHR impacts on bedside caregivers.  The findings substantiate the positive impact of EHRs for nursing and bedside caregivers when the EHR is specifically structured and customized to better meet their needs.

1. Computer-based provider order entry (CPOE) capability reduces medication errors

CPOE is among the most touted EHR capabilities, enabling orders for medications, labs and images with precise, transcription-free, immediate order communication and tracking. Optimal CPOE also ensures immediate, automated communication with bedside caregivers for execution.

So in best EHRs, CPOE is not just about paperlessly sending orders – CPOE is also about relevant and timely communication with Nurses and bedside caregivers.  CPOE is also about ensuring highest safety and quality for caregivers, especially when supplemented by such technological advances as bar-code medication administration.

One organization found that nursing-related medication errors fell 71.7%, falls decreased 83.6%, and acquired pressure ulcers grades 3 and 4 decreased 69.2%.  Exceptionally good nurses became even better.

2. Fewer errors improve satisfaction ratings

Another organization verified reduced errors and quantified favorable patient responsiveness. It also tracked satisfaction changes pre-versus-post-implementation for one year. It found significant improvements from 11.8%-38.5% for ratings on items related to safety, clinical management, documentation and communication.

3. Efficient EHR workflows can give clinicians more time with patients

It has long been asserted – and appropriately so – that bedside caregivers can be more vigilant and clinically effective with increased patient-proximity time. Caregivers can be more clinically expert with more time for observation, awareness and action, versus time spent on other non-care-related chores and tasks.

Two studies (600+ shifts) confirmed 44-minute decrease in documentation time away from patients, and a 21-minute decrease in overall documentation time.  The summary confirmed that the EHR-enabled improvements resulted in nearly 50%-50% mix for nurses in patient-direct versus time away, which was a statistically significant improvement from the nearly 40%-60% patient-direct-indirect work mix before EHR implementation.

Interestingly, these results stand in direct contrast to a HIMSS Analytics industrywide survey of nurses who use a variety of EHRs that are not customized to their needs. This contrast underscores the importance of using EHRs that are locally programmable to meet the needs of bedside caregivers and their patients.

4. Faster response to signs of deterioration

Two additional studies verified significantly reduced length of stay attributed to faster response to symptoms of deterioration and timeliness of intervention. Significantly reduced readmissions were also documented and attributed to improved care continuity during stay, followed by improved discharge preparedness and instructions.

Allscripts Sunrise has the characteristics critical to success for improving nursing and bedside efficacy. The ability to adapt to locally and organizationally important criteria is necessary for achieving success.

* Source: Mythbusters. Authier, Denise; Bradshaw, Pamela; Hickman, Louise; Shaha, Steve // Health Management Technology;Oct2012, Vol. 33 Issue 10, p10

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About the author

Steven H. Shaha, Ph.D., DBA, is a Professor at the Center for Policy & Public Administration, and the Principal Outcomes Consultant for Allscripts. Dr. Shaha received his first doctorate in Research Methods and Applied Statistics from UCLA and has taught and lectured at universities including Harvard, University of Utah, UCLA, Princeton, Cambridge and others. An internationally recognized thought leader, lecturer, consultant and outcomes researcher, Dr. Shaha has provided advisory and consulting work to healthcare organizations including the National Institutes for Health (NIH), and to over 50 non-healthcare corporations including RAND Corp, AT&T, Coca-Cola, Disney, IBM, Johnson & Johnson, Kodak, and Time Warner. Dr. Shaha has presented over 200 professional papers, has over 100 peer-reviewed publications in print, over 35 technical notes and two books. He served on the 15-member team that authored and piloted the Malcolm Baldrige National Quality Award for Health Care, and he contributed to the Baldrige for Education.

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