New Initiative Streamlines Electronic Documentation to Reduce Burden on Nursing Staff

Electronic health records (EHR) have revolutionized healthcare by improving efficiency and patient outcomes. But for nurses and other medical professionals, EHR responsibilities can take valuable time away from clinical care. During a period when caregiver recruitment and retention are of paramount concern nationwide, Cleveland Clinic has launched a new initiative to streamline the EHR process.

“By maximizing productivity, we give our nurses more time for direct patient care and – as a result – increase the pride and satisfaction they have with their jobs,” says Sarah Croes, BSN, MSITM, BGS, RN-BC, SPHIMS, CAPM, Director of Nursing Informatics.

In 2022, Croes and her team spearheaded a major initiative to identify and address inefficiencies in Cleveland Clinic’s Epic EHR system. The project brought together a task force of experts in bedside nursing, quality, practice, accreditation and nursing informatics.

Identifying roadblocks

The team began by assessing how much time inpatient nurses were spending in the EHR: approximately 144 minutes during a 12-hour shift. The task force then identified several major areas for improvement and determined how to reduce documentation time without cutting corners on the quality of information recorded in the EHR.

“We worked hard to arrive at a consensus and ensure that the proposed changes wouldn’t undermine safety or accreditation requirements,” explains Croes. “Our most important consideration was to determine which EHR features impeded clinical care and which actually enhanced it.”

The task force was ultimately able to make several significant improvements, including:

• Care planning – The frequency of documentation was reduced by 60%.
• Flowsheets – The use of flowsheets has helped abbreviate the documentation needs of patients under observation or in extended recovery. The number of patients eligible for focused documentation has now doubled.
• Wounds documentation – Cross encounters were added to improve tracking and image capture. Photographs of a patient’s wounds are now stored in the EHR, where nurses can observe the healing process in real time.
• Alerts – The number of alerts were reduced by 30% to minimize interruptions. For example, alerts during medication administration alone were reduced by 3,000 per day.

A KLAS survey used to evaluate caregiver satisfaction with the revised EHR reflected a substantial improvement in nurses’ attitudes about the documentation system, says Croes. Even relatively simple upgrades like the addition of Secure Chat and more KLAS training opportunities have appeared to boost morale, she notes.

“Nurses appreciate anything we do to remove unnecessary documentation,” explains Croes. “Research shows that hospitals with inadequate EHR technology have higher rates of nurse dissatisfaction and burnout – and worse patient outcomes. We obviously want to avoid those pitfalls and want to do everything we can to provide our caregivers with quick, seamless access to patient records.”

Future opportunities

The initiative, now named EHR Excellence, continues to grow. Among the team’s overarching goals are to optimize the EHR system and reduce average documentation time to 130 minutes per day. Their strategies include automating assignments, enhancing the task-reminder list and removing unused and redundant items, including 80% of online patient summaries.

The team also plans to reduce the number of flowcharts, reduce admission/discharge documentation by consolidating data and removing extraneous items, and reducing alerts by permitting only essential interruptions during medication administration.

Croes says the task force will continue to elicit feedback from nurses and address their requests while providing additional training opportunities and documentation modalities.

“We are continuing to find ways to strengthen our nursing resources and develop a model of care that supports the most efficient workflow possible,” she adds. “We want Cleveland Clinic – and our caregivers – to stay ahead of the curve.”