Electronic Health Records

Adoption & Implementation News

EHR Adoption Positively Impacts Nurses, Clinical Workflows

To ensure improved nursing clinical workflows, leaders must develop a careful EHR adoption plan.

By Sara Heath

- EHR adoption is linked to improved clinical workflows for nursing staffs, helping them to improve the quality of care they provide, new research shows.

ehr-adoption-clinical-workflows

In a study, led by AnneMarie Walker-Czyz, EdD, RN, a research team measured care quality and clinical workflow prior to and following the introduction of an EHR.

The quality measures the team assessed included hospital fall rates, catheter-associated urinary tract infections (CAUTI), central line-associated bloodstream infections (CLABSI), ventilator-associated pneumonia (VAP), and hospital-acquired pressure ulcer (HAPU) rates.

Walker-Czyz and her team also examined the cost of nursing care and nursing turnover and satisfaction.

Overall, EHR adoption had a positive effect on the hospital’s nursing staff. Nearly all clinical quality measures improved, with fall rates reducing by 15 percent and CAUTI and CLABSI rates improving over the course of the study.

While researchers saw an increase in HAPU and VAP rates at the onset of the EHR implementation, those complications eventually improved as well.

EHR adoption also had little effect on the cost of nursing care, with no measurable difference in hospital spending on nurses throughout the course of the study.

However, the researchers did find an increase in nursing staff turnover following EHR implementation. Although staffing numbers remained consistent immediately after the hospital adopted the EHR, turnover increased toward the end of the study.

The nursing staff turnover rates may have been a result of varying levels of health IT competency or the level of EHR sophistication.

On the whole, Walker-Czyz and colleagues reported that EHR adoption for nursing staffs positively impacts care quality.

The study also shows the steps a hospital must follow in order to successfully integrate an EHR into the practice.

“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,” the research team explained.

Nurse leadership while developing an EHR implementation plans is also key, the study shows.

“This study reinforces the power of leadership through innovation adoption,” Walker-Czyz and colleagues wrote.

“Successful EHR implementation requires nurse executives to include bedside nurses in the decision-making process, have effective communications with the ability to trial new practices, and prepare for continuous staffing adjustments.”

In order for hospital leaders to ensure a more successful EHR implementation, they must ensure the hospital environment and the nursing staff is primed for such health IT integration. This includes significant logistical planning and forward thinking on the part of nurse leadership.

“A recommendation for practice would be to increase staffing during the implementation period and throughout the adoption phases. This tactic may mitigate any increased risk of HACs during the implementation phase, as well as reduce nurse turnover.”

Other research confirms these findings. One recent study examined the short-term effects on hospitals following an EHR implementation, and found that hospitals face little disruption after adopting the new technology.

Overall, EHR implementation at 17 different hospitals had little effects on care quality, including 30-day hospital readmissions, mortality rates, and adverse safety events.

The findings from both studies should be good news for hospitals looking to replace their EHR or undergo a robust optimization project. While it long been held that major EHR projects can be enormously disruptive, this new research shows that well-prepared hospitals can be successful in the short- and long-term.

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