Transforming Healthcare Delivery Trifecta: Improving Nurse Efficiency and Satisfaction While Promoting Optimal Patient Outcomes

Ambulatory care staff nurses caring for patients in person, via telephone, or patient portal frequently access patient’s history and contributing information in the electronic health record (EHR) to perform their work. Collecting and documenting relevant details requires navigating multiple sections of the EHR and can delay interactions with patients and/or team members. Concurrently, ambulatory nurse manager (ANM) work requires pulling of EHR data as it relates to workload and/or patient outcomes to drive practice improvement. Nurses have noted finding needed information within the EHR to be time consuming and cumbersome, and it is often expressed as a cause of administrative and cognitive burden. EHR usability issues are noted to negatively impact patient outcomes. In the complexity of today’s healthcare environment, with a growing nursing shortage, nurse workload demands continue to increase. Nurse leaders are being challenged to transform healthcare delivery through innovation and top-of-licensure work with the goal to maximize resources while ensuring optimal patient outcomes. This presentation will highlight the impact nurse-specific EHR views can have on nurse efficiency and satisfaction while promoting optimal patient outcomes.

At a large Midwest academic medical center, an ambulatory care practice solutions workgroup was charged with identifying and implementing initiatives aimed at improving the care of patients with less intensity of caregivers. This collaborative workgroup, comprised of front-line staff, informatics nurse specialists, and nurse leaders held focus groups and identified opportunities to explore and implement EHR solutions that promote practice efficiencies for both front-line staff and ANMs. Four themes emerged: documentation burden, difficulty locating patient information, knowledge deficit in EHR report functionality, and time constraints. Team members acknowledged the value a synthesized ANM dashboard with embedded links to frequently run reports could provide. Team members also noted a specific EHR view that synthesizes patients' key medical information, while commonly used by providers, has not been widely implemented in nursing, would be of value. Using the DMAIC model, an ANM dashboard, and the creation of a nurse-specific synthesized EHR view were selected, with the aim to improve nurse efficiency and satisfaction navigating the EHR by 20% by December 31, 2023. Workgroup members met with key stakeholders to develop the two EHR synthesized views. Evidence-based tools were utilized to collect baseline and post-pilot data measuring cognitive demand, work efficiency, performance, and behavior change. Subject matter experts (SMEs) were identified within each pilot unit to serve as embedded change agents. Education was provided one-week prior to go-live, with SMEs available throughout the pilot period to assist with real-time trouble shooting and to convey feedback to the workgroup. The two views were piloted in four diverse practices subspecialties for one month. Preliminary outcome data is positive, with participant feedback identifying additional enhancements to further improve nurse efficiency and satisfaction. Outcome data will be showcased along with key lessons learned and feasibility of replication.