Essential Nurse Documentation: Studying EHR Burden during COVID-19 (ENDBurden)

项目总结/摘要 这种混合方法的信息学研究采用了一系列数据科学方法， 访谈和EHR文档，目标是从 2019冠状病毒病大流行，减轻电子病历负担。注册护士的EHR负担已被证明， 增加了记录时间、记录量、工作量、倦怠以及与贫困患者的联系 结果。减少EHR负担是国家的优先事项，然而，没有明确的证据来区分 文件类型对于支持患者护理是必不可少的。认识到工作量需求增加， 在COVID-19大流行期间，纽约发布命令，放宽对以下人员的文件要求： 临床医生，包括护士。因此，纽约大流行期间的护士记录反映了 护士认为最重要的信息-提供了一个独特的和罕见的自然实验研究 文件负担。相反，密苏里州是新冠肺炎病例总数排名第18位的州， 也没有类似的州命令为了推进科学，我们将从一个 数据科学和信息学的角度，发现哪些文档模式（即，类型、数据量 输入和查看），并检查文档模式随时间的变化 从大流行之前一直到现在我们知道EHR负担存在，但它不被理解 哪些文档模式解释并影响患者护理活动与患者之间的关系 结果。我们将使用基于时间的EHR日志文件来衡量患者护理活动，并将其操作化为"总体 轮班时间"减去"记录患者护理活动或查看数据所花费的时间"。我们将针对呼吸系统 急性和重症监护患者的护理管理，还包括重症监护患者的谵妄护理管理 护理患者-适用于住院COVID-19和非COVID-19患者的结局。具体 目的是：目的1：检查护理数据输入和数据查看模式的时间趋势变化 文档（例如，2019年至今（包括COVID-19大流行）， 时间轴。目标二： 调查护士如何定义和决定什么是必不可少的文件为病人护理 以及包罗万象的文档的影响（即， 符合临床和法规要求的文件 要求） EHR负担 .目的3：检查护理数据输入和数据查看模式的变化 记录以及这些变化对患者护理活动和患者结局的影响， 控制与工作量、护士、患者、团队和组织相关的混杂因素 特色

PROJECT SUMMARY/ABSTRACT This mixed-methods informatics study employs a series of data science methods triangulating data from Interviews and EHR documentation, with the goal to identify essential documentation from the COVID-19 pandemic and reduce EHR burden. EHR burden for registered nurses has been demonstrated by increased documentation time, documentation amount, workload, and burnout and linkages to poor patient outcomes. Decreasing EHR burden is a national priority, yet, there is no clear evidence to differentiate which types of documentation are essential to support patient care. In recognizing the increased workload demands during the COVID-19 pandemic, New York issued orders that relaxed documentation requirements for clinicians, including nurses. Therefore, nurses’ documentation during the pandemic in New York reflects the information deemed most essential by nurses – providing a unique and rare natural experiment to study documentation burden. On the contrary, Missouri ranked as the 18th highest state for COVID cases overall, and had no similar state orders. To advance the science, we will learn about nurses’ documentation from a data science and informatics perspective, discover which documentation patterns (i.e., types, amount of data entry and viewing) are deemed essential by nurses, and examine documentation pattern changes overtime from before the pandemic through present day. We know that EHR burden exists, yet it is not understood which documentation patterns explain and influence the relationship between patient care activities and patient outcomes. We will use an EHR log-file time-based measure of patient care activities, operationalized as “total shift time” minus “time spent documenting patient care activities or viewing data”. We will target respiratory care management for acute and critical care patients and also include delirium care management for critical care patients - applicable outcomes for both hospitalized COVID-19 and non-COVID-19 patients. The specific aims are to: Aim 1: Examine changes in the temporal trends of data entry and data viewing patterns of nursing documentation (e.g., types, amount) from 2019 through present day, inclusive of the COVID-19 pandemic timeline. Aim 2: Investigate how nurses define and decide what is essential to document for patient care and the impact of all-inclusive documentation (i.e., documentation that meets both clinical and regulatory demands) on EHR burden . Aim 3: Examine changes in data entry and data viewing patterns of nursing documentation and the impact of these changes on patient care activities and patient outcomes, while controlling for confounding factors related to workload, and nurse, patient, team, and organizational characteristics.