Improving Efficiency and Patient Care with On-line Clinical Documentation

Doylestown Hospital
Doylestown, PA

About Doylestown

Doylestown Hospital is a comprehensive, community-focused healthcare facility serving patients and families in the northern suburban communities of Philadelphia, including Bucks and Montgomery Counties in Pennsylvania and Hunterdon and Mercer Counties in New Jersey. From its inception as a 14-bed emergency and maternity hospital, Doylestown Hospital has grown into a regional healthcare resource encompassing more than 500 acute and long term care beds in three locations: Doylestown Hospital, Pine Run Health Care Center, and Pine Run Lakeview.

Like many of today's health care institutions, Doylestown Hospital (Doylestown, PA) is faced with the simultaneous challenge of improving services for its patient base while coping with the nursing shortage. In the spring of 2003, while participating in an Advisory Board initiative to increase nursing efficiencies, Doylestown determined that a solution for meeting both challenges was an on-line clinical documentation system.

“On-line documentation allows nurses to have access to medical records and references right at their fingertips, and up-to-the-minute, accurate test results can be accessed while a nurse is assessing a patient or writing notes,” says Patricia Lawson, critical care instructor.

Beginning in July 2003, Doylestown, a 194-bed facility that houses various outpatient services as well as acute care, Rehab, ICU, PCU and cardiovascular intensive care units, began its transition from a paper to an electronic documentation system. They targeted an aggressive December 2003 date for going LIVE with multidisciplinary on-line documentation throughout nursing, respiratory, case management, clinical nutrition, and rehabilitation, among other therapies that provide care to patients. Five months later, Doylestown met its goal and went LIVE with on-line documentation for all care providers, utilizing bedside wireless devices.

From Zero to Sixty

The hospital credits the speedy five-month implementation to an organized and dedicated staff with a desire to learn, and to the intuitiveness of the integrated, MEDITECH HCIS they’ve been using for the past thirteen years. A particular challenge that Doylestown faced during this time was that staff members had such a broad range of computer experience.

“We were training some nurses who had never used a keyboard before,” says Carol Muhlbauer, clinical analyst at Doylestown. “We wanted our nurses to feel that they had ownership of the documentation and to be confident in using the system. Our staff members were willing to train during every day of those five months, including occasional weekends. Now, the nurses feel like they do have ownership and they do understand the system.”

Ted Harrison of ISA Consulting was brought into the project team and completed a detailed project plan for Doylestown. The project plan was broken into seven teams, of which 48 staff members were assigned various tasks ranging anywhere from developing dictionaries and building screens, to coordinating training.

“We wanted the staff at Doylestown to look at on-line documentation not as anything new, but as an ‘evolution’ of their existing system, a concept that was less intimidating,” says Harrison. “The goal was for staff to see this change not as a barrier, but as a way for them to simply move forward with the system.”

Forms Follow Function

Paper forms played an unexpectedly critical role in Doylestown's implementation. During the implementation process, every form used for paper documentation was analyzed, with the goal of moving all paper processes on-line. “We tried to mimic the forms as they were on paper, and the MEDITECH system made it easy for us,” says Muhlbauer. “We wanted to eliminate redundancy and operate under a philosophy of ‘document once, use as many times as needed.’”

Making the process even easier for staff was Doylestown’s ability to create pop-up “help screens,” putting protocols online, and to provide on-line documentation behind some interventions. “Documentation associated with queries also helped the nurses, allowing them to read the documentation as they enter orders,” says Muhlbauer.

Doylestown successfully put 130 forms on-line and is now documenting with various routines including assessments, care plans, process interventions, patient notes, reports, and query links, along with protocols and some canned text. “We've eliminated redundancy and standardized the way the hospital is documenting. This allows our nurses to move more easily from one floor to the other in the event a floor is short-staffed,” says Muhlbauer.

Praise from Users, Reviewers Alike

The nurses at Doylestown can now provide better patient care, as streamlined documentation reduces errors and eases a patient’s departmental transfer. The burden of paperwork is reduced, legibility issues are eliminated, and communication among caregivers is improved.

“Now that we are LIVE, the documentation can easily be found all in one place, under Patient Care Inquiry (MEDITECH's electronic medical record application)," says Sharon Heacock, R.N. a Progressive Care Unit nurse at Doylestown. "Since every unit is documenting on the same nursing assessment form, it is not as stressful when we're pulled to another unit."

The inherent integration of MEDITECH’s software has also been a key element to the success of on-line documentation at Doylestown. “The integration of our system allows nurses to see key patient information repopulate from admission to admission,” says Muhlbauer. "Physicians now have the ability to view information anywhere in the hospital or from their offices, and pharmacists don’t have to find charts or make phone calls in order to see data or enter medications. Overall, the system is much more efficient, and benefits both our caregivers and our patients.”

Hospital officials believe that this type of nurse satisfaction with the on-line documentation system will help them to retain staff. “The nurses realize that it’s much more efficient, and there’s a new clarity to the information,” says Harrison.

Caregivers aren’t the only ones praising the new system in place at Doylestown. This past March, the Commission for Accreditation of Rehabilitation Facilities (CARF), a peer-review, which maintains standards and services provided in all aspects of rehabilitation, visited Doylestown. According to Muhlbauer, Doylestown received a glowing review from The Board. “CARF thought that our documentation system was thorough and integrated. They particularly noted our interdisciplinary charting method, with which all caregivers can review and comment on the care of patients.” CARF also commended the hospital’s ability to see a complete patient record in Patient Care Inquiry and the ability to extract data using MEDITECH’s NPR Report Writer.

Progress at Doylestown doesn't stop with on-line clinical documentation, as the hospital has many plans for future clinical implementations and patient safety initiatives. "We're going forward with MEDITECH's On-line Medication Administration Record, Bedside Medication Verification, Emergency Department Management, and eventually, MEDITECH’s CPOE solution (Provider Order Management)," says Muhlbauer. "We view our comprehensive clinical documentation system as the crucial first step in an ongoing process of automating -- and ultimately improving -- patient care."