UK HealthCare State of the Union

Can Electronic Medical Records Improve Multidisciplinary Communication for Orthopaedic Trauma Patients?

A Quality Improvement InitiativeJeremy Burnham, MDPhilip Ashley, MDAaron Carpiaux, MDStephen Duncan, MDKevin Murr, MDTodd Milbrandt, MD

As part of our quality improvement project, we worked with hospital administration and IT personnel to provide suggestions, develop improvements to existing functionality, customize our note, and facilitate the transitionBackgroundThe HITECH Act incentivized a transition to EHRPart of the Stimulus in 2009 In October 2013, our trauma service transitioned from a paper-based History & Physical form to a computer-based document- 2 -

Paper H&P- 3 -

Computer H&P- 4 -

BackgroundPurpose of the study: to evaluate the effect of an electronic H&P form on multidisciplinary communication and to evaluate any time differences for document completionHypothesis: the electronic H&P would improve communication among multidisciplinary team members but would take longer to complete- 5 -

Background

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MethodsTwo Main Components:Survey to Nurses, PT/OT, and HousestaffAnalyze H&P Completion TimeSurveySent anonymouslyQuestions looked at communication, time, satisfaction with notes, preference of formats, suggestions- 7 -

Methods H&P TimeRandomized consults to either Paper or ComputerExcluded hand consults, spine consults, floor consults, and patients which were intubated or rushed immediately to the ORRecorded variables related to complexity of patientsNumber of ortho diagnoses, number of past medical history items, number of past surgical history items, number of medications- 8 -

Methods H&PsRandomization protocolRandomized immediately when consult received, prior to seeing patientGraphPad Randomizer (2014 GraphPad Software, Inc) http://www.graphpad.com/quickcalcs/randomize2 Timing ProtocolStarted timing when at start of patient interviewPaused during physical exam, treatment/interventionsRestarted when document entry resumedStopped after initial assessment and plan was complete- 9 -

How it works: The random number generator is seeded with the time of day, so it works differently each time you use it. Each subject is first assigned to a group nonrandomly. Then the assignment of each subject is swapped with the group assignment of a randomly chosen subject. This should suffice, but the entire process is repeated twice to make sure it is really random. Note that you can copy and paste the values from the web page into Excel.

http://www.graphpad.com/quickcalcs/randomize2/ 9

Results- 10 -

Results SurveysEasy to Find and Read?Know the Plan of Care?Know the Follow-up and Dates?Improves/Facilitates Communication?- 11 -4 Comparison Questions:

How it works: The random number generator is seeded with the time of day, so it works differently each time you use it. Each subject is first assigned to a group nonrandomly. Then the assignment of each subject is swapped with the group assignment of a randomly chosen subject. This should suffice, but the entire process is repeated twice to make sure it is really random. Note that you can copy and paste the values from the web page into Excel.

http://www.graphpad.com/quickcalcs/randomize2/ 11

Results- 12 -

Results SurveysImproved Care?Saved the Respondent Time?- 13 -2 Transition Questions:

How it works: The random number generator is seeded with the time of day, so it works differently each time you use it. Each subject is first assigned to a group nonrandomly. Then the assignment of each subject is swapped with the group assignment of a randomly chosen subject. This should suffice, but the entire process is repeated twice to make sure it is really random. Note that you can copy and paste the values from the web page into Excel.

http://www.graphpad.com/quickcalcs/randomize2/ 13

Results- 14 -

Results- 15 -

Results H&PCompletion Time

- 16 -H&P Analysis

How it works: The random number generator is seeded with the time of day, so it works differently each time you use it. Each subject is first assigned to a group nonrandomly. Then the assignment of each subject is swapped with the group assignment of a randomly chosen subject. This should suffice, but the entire process is repeated twice to make sure it is really random. Note that you can copy and paste the values from the web page into Excel.

http://www.graphpad.com/quickcalcs/randomize2/ 16

Results H&P- 17 -FormatNPMHPSHMedsTotal PMHOrtho DiagnosesTimeComputer311.7 0.371.18 0.211.00 0.313.48 0.641.13 0.06896.3Paper332.7 0.531.73 0.322.03 0.415.88 1.111.03 0.03472.5P-value0.1250.1580.0510.0690.146