Abstract
Background
Nursing documentation burden is a growing point of concern in the United States health
care system. Documentation in the electronic health record (EHR) is a contributor
to perceptions of burden. Efficiency tools like flowsheet macros are one development
intended to ease the burden of documentation.
Objective
This study aimed to evaluate whether flowsheet macros, a documentation efficiency
tool in the EHR that consolidates documentation into a single click, reduces the time
spent on documentation activities and the EHR overall.
Methods
Nurses in the health system were encouraged to create and utilize flowsheet macros
for their documentation. Flowsheet documentation and time in system data for nurses'
first and last shifts in the evaluation period were extracted from the EHR. Linear
regression with control variables was utilized to understand if the utilization of
flowsheet macros for documentation reduced the time spent in flowsheets or the EHR.
Results
The results of linear regression showed a significant, negative relationship between
flowsheet macros use and time in flowsheets (adjusted odds ratio [AOR] = −0.291, 95%
confidence interval [CI] = −0.342 to −0.240, p < 0.001). Flowsheet macros use and time in system also had a significant, negative
relationship (AOR = −0.269, CI = −0.390 to −0.147, p ≤ 0.001). Subgroups for department specialties showed time savings in flowsheet activities
for medical surgical, critical care, and obstetrics units, however, a significant
relationship was not found in emergency and rehabilitation units.
Conclusion
Utilization of flowsheet macros was associated with a decrease in the amount of time
a nurse spends in both flowsheets and the EHR. Adoption and timesavings varied by
the department setting, suggesting flowsheet macros may not be applicable to all patient
types or conditions. Future research should investigate if the time savings from this
tool yield benefits in perceptions of nurse documentation burden.
Keywords
nursing - documentation burden - electronic health record - efficiency
