The impact of an electronic health record on nurse sensitive patient outcomes: An interrupted time series analysis

Article (PDF Available)inJournal of the American Medical Informatics Association 19(4):615-20 · December 2011with199 Reads
DOI: 10.1136/amiajnl-2011-000504 · Source: PubMed
To evaluate the impact of electronic health record (EHR) implementation on nursing care processes and outcomes. Interrupted time series analysis, 2003-2009. A large US not-for-profit integrated health care organization. 29 hospitals in Northern and Southern California. An integrated EHR including computerized physician order entry, nursing documentation, risk assessment tools, and documentation tools. 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). 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). 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.
    • "The observation of fewer complications in the intervention group suggests the combination of a practical risk identification strategy and a team approach to integrating care may be more successful than an identification strategy (e.g., SPICES) alone. Similarly, experience with the impact of EMRs on inpatient outcomes is mixed, particularly for adverse events during hospitalization (Buntin, Burke, Hoaglin, & Blumenthal, 2011; Furukawa, Raghu, & Shao, 2010; Dowding, Turley & Garrido, 2012 ). A report by one academic medical center suggests that EMRs may support the implementation of team-based care (O'Leary et al., 2011). "
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    • "At an organisational level the nurse managers we spoke to clearly the ability to use data from KP HealthConnect™ to audit and monitor care quality on a shift by shift basis. In a separate study we have demonstrated that the introduction of KP HealthConnect™ was associated with an improvement in outcomes for patients related to pressure ulcers but not falls [41]. However, what is not clear is if or how the behaviors we observed in this study are related to the observed improvements in patient outcomes. "
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