The impact of an electronic health record on nurse sensitive patient outcomes: an interrupted time series analysis

Abstract

Objectives: To evaluate the impact of electronic health record (EHR) implementation on nursing care processes and outcomes.

Design: Interrupted time series analysis, 2003-2009.

Setting: A large US not-for-profit integrated health care organization.

Participants: 29 hospitals in Northern and Southern California.

Intervention: An integrated EHR including computerized physician order entry, nursing documentation, risk assessment tools, and documentation tools.

Main outcome measures: Percentage of patients with completed risk assessments for hospital acquired pressure ulcers (HAPUs) and falls (process measures) and rates of HAPU and falls (outcome measures).

Results: EHR implementation was significantly associated with an increase in documentation rates for HAPU risk (coefficient 2.21, 95% CI 0.67 to 3.75); the increase for fall risk was not statistically significant (0.36; -3.58 to 4.30). EHR implementation was associated with a 13% decrease in HAPU rates (coefficient -0.76, 95% CI -1.37 to -0.16) but no decrease in fall rates (-0.091; -0.29 to 0.11). Irrespective of EHR implementation, HAPU rates decreased significantly over time (-0.16; -0.20 to -0.13), while fall rates did not (0.0052; -0.01 to 0.02). Hospital region was a significant predictor of variation for both HAPU (0.72; 0.30 to 1.14) and fall rates (0.57; 0.41 to 0.72).

Conclusions: The introduction of an integrated EHR was associated with a reduction in the number of HAPUs but not in patient fall rates. Other factors, such as changes over time and hospital region, were also associated with variation in outcomes. The findings suggest that EHR impact on nursing care processes and outcomes is dependent on a number of factors that should be further explored.

Figure 1

(A) Example of alert for pressure ulcers. (B) Flow sheet documenting preventive actions for pressure ulcers.

Figure 2

Impact of an electronic health record system on documentation of risk for falling or hospital acquired pressure ulcer (HAPU).

Figure 3

Impact of implementation of an electronic health record system on hospital acquired pressure ulcer (HAPU) rate.

Figure 4

Impact of implementation of an electronic health record system on fall rate.