Example 4: Redesigning Hospital Workflow

Issues Encountered

A two-hospital health system preparing to implement a new nursing documentation and ordering system assembled an interdisciplinary team to assess their current patient admission processes. They determined that there was significant duplicate documentation in the nurses' workflow. For example, according to hospital policy, nurses were required to fill out an electronic social functional assessment form within 24 hours of a patient's admission. The data collected by this form overlapped considerably with data collected on a paper admission form that was also filled out by nurses. Ancillary departments were being flooded with duplicate referrals via the paper and electronic systems. The departments wasted time reconciling paper referrals with electronic ones, trying to weed out the duplicates.

Finding a Solution

The team decided to address the problem by mapping out the admission data collection process using flow diagrams. They soon identified several ways to improve the process. First, they incorporated the functional assessment into the EHR's electronic admission form and implemented point-of-care documentation. Next, they made sure that data from previous visits and disparate systems could be incorporated into the central electronic record. Finally, they developed an automated referrals system to notify specific ancillary departments based on admission data from the EHR. Other existing policies and procedures were reviewed to ensure that they did not conflict with the new process. The process redesign, in combination with the new EHR, reduced duplicate documentation, improved communication, and increased nurse satisfaction.

Lesson Learned: 
  • Duplication across paper and electronic systems or across disparate electronic systems can lead to unintended consequences.
  • EHR implementation or modification provide an opportunity to reevaluate and redesign current processes.
  • Process assessment should be conducted in a systematic way using tools such as flow diagrams.

Guite J, Lang M, McCartan P, et al. Nursing admissions process redesigned to leverage EHR. J Healthc Inf Manag 2006; 20(2): 55-64.

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