A mixed-methods assessment of time spent documenting by nurses using an electronic medical records system

The focus of this quality improvement project was to identify possible improvements to the nursing documentation process at a large academic medical center by developing an understanding of the root causes of electronic medical records documentation inefficiencies, as decreasing the amount of time spent on documentation would allow for increased nurse interaction time with patients. The root cause analysis conducted in this study was grounded in a mixed methods approach, incorporating ethnographic observations, focus groups, and surveys with follow-up interviews. Additionally, phone-based work sampling was conducted to establish a baseline measure of documentation time efficiency. Data were collected from 121 nurses over six months, in four acute care units and one emergency department at the University of Virginia Medical Center. Focus group feedback, observations, and survey data were aggregated and used to identify five categories of possible improvements to the efficiency of documentation: user interface, equipment, process, communication, and extent of documentation. Survey data suggest that a significant proportion of nurses had never used several time-saving tools. When triangulated with the qualitative results, these findings suggest that nurses who understand and use built-in documentation tools spend less time on documentation overall. Work sampling results showed that 45.8% of time was spent on patient care, 16.5% on indirect care, 25.6% on documentation and 12.0% on miscellaneous tasks. While in line with findings from the literature, these task time distributions suggest the potential for further reduction to nursing time spent documenting through efforts to improve training consistency, remove unnecessary or repetitive documentation, and encourage use of time-saving tools.