For three years, Carolinas Healthcare System worked on optimizing clinical documentation among the nursing staff.

How comprehensive was the final result? “We removed 18 million clicks out of the documentation workflow,” says Becky Fox, chief nursing informatics officer.

The organization knew such an effort could make tasks significantly easier for nurses. One team looked for duplicate documentations and cleaned them up, while another team worked with clinical nurses and subject matter experts on creating new workflows. In all, 50 experts and several hundred nurses participated.

Rebecca Dunlap
Rebecca Dunlap

“We have had an electronic health record system for 10 years, so while we were focused on the meaningful use program, we have not leveraged the EHR technology to make sure we were using all of its functionality to its highest level,” Fox adds.

Some changes were simple, yet made a big impact, says Rebecca Dunlap, assistant vice president of patient care services at Carolinas Healthcare System-Northeast, which includes a 457-bed hospital in Concord. “We changed the font size on the screen because the average nurse is age 40 or older. Ten years ago, we got 15-inch monitors; now, we have 22-inch monitors.”

Operational improvements from the optimization program included a 14 percent increase in on-time medication administration, 20 percent reduction in time to complete head-to-toe assessment which equates to 35,000 nursing hours returned to patient care, implementation of 10 new screening tools that will save $60,000 annually and $1 million in cost avoidance by changing from traditional classroom training to web-based training and hands-on scenario practice sessions.

During the project, the organization learned that optimization is something not to be done occasionally but on a continuous basis, according to Dunlap. There should be an ongoing process to evaluate how to make life easier for nurses, she adds.

“Constantly look at availability of systems, and constantly look at how to make things better before the customer—the nurse—asks,” Fox advises.

Fox and Dunlap will dig deeper into the optimization project during an educational session at HIMSS18. Session 270, “Clinical Optimization: Partnership, Success and Lessons Learned,” is scheduled at 4:00 on Thursday, March 8 in room Murano 3304.

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