P0029 - Saving Time for Patient Care by Optimizing Physicians’ Notes Templates

Background: Introducing Electronic Health Records (EHR) into health care intended to improve patient care and organizational efficiency. However, not optimized EHR note templates require spending longer hours behind the computer, shorter time with patients, suboptimal patients safety, providers dissatisfaction and physicians burnout.

Objectives: This study explored whether optimizing physicians’ notes save time for patient care, improve provider satisfaction and patients safety.

Methods: This study was conducted in our level 1 Mother-Baby Unit at an academic institution in Northeast Florida. 4 types of notes were optimized in October 2015 after several meetings with EHR analysts: History and Physical (H&P), Discharge summary (DC summary), progress notes, and hand-off list. The first optimization step was to identify all free text elements documented elsewhere in medical records (e.g. delivery information, maternal data, and lab result). The elements were then replaced with dynamic “SmartLinks” that automatically populate portions of the note. The second step was to identify the remaining free text elements that could be replaced with “SmartLists.” The new note templates were given new SmartLinks to increase ease of use and accessibility. The Pediatrics team, who care for infants admitted to Mother-Baby unit, were trained on how to find the new note templates. 4 years later, a report for the number of infants admitted between 1/2016-9/2019 (45 months) was requested from our Data Solution Center. The generated report result was 9373 infants were admitted to Mother-Baby Unit during the requested period. Average Length of Stay (LOS) was 2 days. Every infant requires an average of 4 notes: H&P, progress note, DC summary and daily updated hand-off list. Reducing actions taken by completing the new templates when compared with the old templates was calculated. Actions taken were defined as clicks, keystrokes, transitions and mouse-Keyboard switches.

Results: Total actions saved were 69, defined as:
H&P: 11, Progress note: 8, D/C summary: 18, Handoff: 32.
Old note templates and new note templates were filled for the same infant by the same personnel and the time spent to write each note was documented by seconds. The new notes took shorter time to write. Time saved by seconds was divided by the number of actions saved. Results averaged 20 seconds saved time per one action.
69 actions x 20 seconds = 1380 seconds = 23 minutes per infant during LOS of 2 days.
208.4 infants delivered per month, 4793.2 minutes saved per month = 80 hours = 2.6 hours is saved per day in the Mother-Baby unit via notes' optimization.
This has resulted in improving provider satisfaction and decreased physician’s burnout as stated by the providers in surveys, reviews, emails and meetings.

Conclusion: Optimizing physicians’ notes templates in EHR resulted in significant time saving of 2.6 hours per day.