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Study: Implementation of Integrated EHR System Improved Nursing Care Quality

July 28, 2016
by Heather Landi
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Incorporating electronic, evidenced-based practice tools into bedside nurses’ workflow promotes decision making at the point of care, which may improve patient care quality, such as reducing hospital-acquired falls, according to a study published in The Journal of Nursing Administration.

However, one interesting finding from the study at St. Joseph’s Hospital Health Center in Syracuse, New York was a significant increase in nurse turnover following the implementation of an electronic health record (EHR) system.

The author of the study, AnneMarie Walker-Czyz, EdD and R.N. at St. Joseph’s Hospital Health Center, wanted to examine the impact of an integrated EHR adoption on the quality of nursing care delivered. According to Walker-Czyz, little is known about the adoption patterns of computerized documentation by nursing and the effects on the practice environment.

For the study, the researcher analyzed the implementation of an EHR at the 431-bed urban hospital, with 10 medical surgical units and two critical care units, using the diffusion of innovations (DOI) theory. The author wrote, “The science of DOI focuses on three major categories:  perception of the innovation, characteristics of people who adopt the innovation or do not, and contextual factors such as communication channels, rewards, and organizational leadership support. The adoption of innovations and incorporation of evidenced-based research into healthcare systems are challenging yet necessary evolutions. Rogers DOI model provides a process to explore the factors contributing to how an innovation is rejected or accepted by a group of individuals.”

Specifically, the researcher analyzed hospital-level data to examine the impact of the EHR implementation on the quality of nursing care delivered as measured by hospital-acquired falls, hospital-acquired pressure ulcer rates, ventilator-associated pneumonia, central line-associated bloodstream infections, and catheter-associated urinary tract infections. The study also looked at the impact of the integration of EHR tools on cost and nurse turnover rates before, during and after implementation.

According to the findings of the study, overall, the implementation of an integrated EHR can positively impact quality outcomes, as fall rates decreased by 15 percent after implementing the EHR software. Catheter-associated urinary tract infection and central line-associated bloodstream infection rates significantly improved over time from the pre-intervention to post-intervention period.

According to the study, there was a delayed effect on rates of hospital-acquired pressure ulcer and ventilator-associated pneumonia, as those rates were negatively impacted at the implementation period followed by a significant positive rate reduction that surpassed the pre-implementation period.

And, as mentioned above, the study findings also indicated higher-than-expected nurse turnover after implementation. And, at the same time, the study found that the cost of care, as measured in hours per patient day and overtime, was not significantly affected.

“However, this finding about may inform the higher-than-expected nurse turnover results over time because staffing patterns may not have been supported throughout the adoption period; increased costs related to nurse turnover may have resulted. The impact of EHR implementation on nurse staffing might vary by the level of sophistication of the EHR, user, and phases of adoption,” the study author wrote.

The researcher concluded, “This study confirms that nurses have the ability to positively impact the quality of patient care through successful innovation adoption related to computerized documentation at the bedside. To provide excellent patient care and maintain control over their work environment during the implementation of an EHR, a combination of changes must occur, including development of evidenced-based education with standards of care, monitoring of practice standards, redesign of nursing units for efficiency, and a modification of certain nursing activities.”

And the study author wrote, “Future research studies are warranted regarding how nurses use EHR resources for decision making. Continued research is also necessary to identify RN turnover risks and mitigation strategies after innovation adoption including implementing an EHR.”

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