The impact of an integrated electronic health record on nurse time at the bedside: a pre-post continuous time and motion study

Background: Evidence about the effectiveness of electronic health records in improving nursing workload efficiency is uncertain. Aim: To measure, compare and describe nurse time spent on patient care prior to, and following implementation of an integrated electronic health record roll-out using a standardised approach. Design: Structured, continuous observation, pre-post time and motion design. Methods: Continuous observations took place in general wards in surgical and medical divisions of a tertiary hospital in South East Queensland from November 2015 to July 2017. Trained nurse observers independently observed and recorded patient care provided by consenting direct-care nurses over the course of an entire clinical shift in surgical wards or during medication rounds in medical wards. Care activities were timed and coded into categories (direct care, indirect care, ward related activities, documentation, personal and miscellaneous activities), and additional elements that influence nursing care. Descriptive statistics including frequency, percentages and median duration were reported for care activities with differences between pre- and post-implementation reported. Findings: Direct-care nurses (n = 51) were observed for the duration of an entire clinical shift or during a medication round with a total of 6209 activities observed in both divisions. Most nursing activities occurred at the patient's bedside prior to and following the implementation of an integrated electronic health record. In the surgical division, direct care activities (such as assessing patient needs and preparing and administering ordered medications), and ward related activities (such as cleaning and clerical work) showed a significant decrease (p