Enhancing Working Flow Efficiency With EMR Ventilator Data Integration

Abstract

Background: RT workflow has the potential to be more efficient by integrating ventilator data into the electronic medical record (EMR). Data integration should lessen EMR associated fatigue, increase more face-to-face patient care, and decrease transcription errors. Changing the design of the EMR flowsheet has the possibility to decrease errors and improve safe handoff by improving accuracy of data entered.

Methods: The RT division partnered with the IT department to develop a process improvement plan. The Servo U, Trilogy 202, EVO EV300 and INOmax DSIR Nitric Oxide are the devices that needed to be integrated into the EMR. Servo U, Trilogy 202, INOmax DSIR had existing parm IDs to integrate the ventilator data into the EMR. The RT/IT department worked with the engineers at Phillips and Baxter to develop parm IDs for the EV300 and EVO. The ventilator flowsheets were restructured to improve visualization of patient data and settings. Prior to ventilator integration all ventilator data was on one flowsheet. This was cumbersome to not only document but put the RTs at risk to pass along incorrect information or increase transcription error. Ventilator data updates every minute into EPIC. Data needs to be validated into EPIC for the data to become part of the medical record. All unvalidated data remains in the chart for 72 h. Improved efficiency will be measured by keystrokes, clicks and time in seconds.

Results: Pre and post data was measured for keystrokes, clicks and time (s). Prior to integration the average time to enter a ventilator check was 111 s, 39 clicks and 46 keystrokes. After integration the average time to a ventilator check was 64 s, 14 clicks and 8 keystrokes. The total time to enter a nitric oxide check was 360 s. The total time post integration was 90 s.

Conclusions: On average there was a 42% reduction in time spent entering a ventilator or nitric oxide check. There was a 64% reduction in clicks and an 83% reduction in keystrokes. The reduction in keystrokes significantly reduces the chance for transcription errors. Integrating ventilator data into EPIC improved end user support and flowsheet design. Reducing time spent entering data allows for more time to be spent with the patient. Overcall care and accuracy has the potential to increase staff satisfaction. Safe handoff improved due to the accuracy of the information displayed. We will continue to work with the IT department to integrate more devices as technology allows.