A Time and Motion Analysis of Nursing Workload and Electronic Health Record Use in the Emergency Department

Bakhoum, Nicole; Gerhart, C.; Schremp, Emma; Jeffrey, Ashley; Anders, Shilo; Ward, Michael J.

doi:10.1016/j.jen.2021.03.007

Cited by 10 publications

(15 citation statements)

References 38 publications

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“…Empirical evidence of emergency nurses' high CMW is reported in several studies (Bakhoum et al, 2021;Forsyth et al, 2018;Kim et al, 2019;Yuan et al, 2023). Forsyth et al (2018) reported that emergency nurses experience an average of 85 interruptions in a shift and was concerned about the cognitive demand imposed on them.…”

Section: Complexity Of Nursing Workmentioning

confidence: 99%

“…Kim et al (2019) explored the effect of interruption on the mental workload of emergency nurses in simulation setting and found a statistically significant positive correlation. Whereas the time motion study by Bakhoum et al (2021) pinpointed the effect of information technology on emergency nurses' cognitive workload experiences. The metaanalysis of 31 quantitative study including 16,189 nurses performed by Yuan et al (2023) reported that mental workload experiences of nurses estimated using NASA TLX were documented to be high.…”

Section: Complexity Of Nursing Workmentioning

confidence: 99%

“…Empirical evidence of emergency nurses' high CMW is reported in several studies (Bakhoum et al., 2021; Forsyth et al., 2018; Kim et al., 2019; Yuan et al., 2023). Forsyth et al.…”

Section: Introductionmentioning

confidence: 97%

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Cognitive mental workload of emergency nursing: A scoping review

Surendran,

Beccaria,

Rees

et al. 2024

Nursing Open

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AimEmergency nurses work in an environment of high cognitive mental workload. Excessive cognitive mental workload may result in patient harm and nurses' burnout. Therefore, it is necessary to understand nurses' subjective experience of cognitive workload. This scoping review aimed to curate literature about the subjective experience of cognitive mental workload reported by nurses and psychometric measures of the phenomenon.DesignThe scoping review was conducted in accordance with JBI methodology and reported using PRISMA extension for scoping review checklist.MethodsA priori protocol was created with Peer Review of Electronic Search Strategies checklist and registered in the OSF registry. Databases including PubMed, CINAHL, ProQuest, Scopus, Science Direct, Web of Science and Google Scholar were searched. Published reports were reviewed against the eligibility criteria by performing Title and Abstract screening, followed by Full‐text screening. The initial search yielded 1373 studies. Of these, 57 studies met the criteria for inclusion in this study.ResultsThe search revealed five general measures of cognitive mental workload and their variations. Only one customised measure specifically for medical–surgical nurses was found in the study. Identified measures were collated and categorised into a framework for conceptual clarity. NASA Task Load Index and its variations were the most popular subjective measure of cognitive mental workload in nursing. However, no measure or self‐report scale customised for emergency nurses was identified.Patient or Public ContributionThe findings of this scoping review can inform future research into the cognitive mental workload of nurses. The findings have implications for workplace health and safety for nurses and patients.

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Section: Complexity Of Nursing Workmentioning

confidence: 99%

Section: Complexity Of Nursing Workmentioning

confidence: 99%

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Cognitive mental workload of emergency nursing: A scoping review

Surendran,

Beccaria,

Rees

et al. 2024

Nursing Open

View full text Add to dashboard Cite

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“…Evidence suggests that electronic health record (EHR) design and workflows fail to optimally meet the needs of ED workflows 9–11 —their incongruencies often leading to excess work and time-consuming workarounds. 11 EHR configurations (eg, supporting regulatory compliance and quality improvement efforts) have intensified ED physician 9 , 12 , 13 and nurse 14 workload, particularly, noncare-related documentation. Consistent with Cohen et al, 15 we define EHR documentation burden as additional work (ie, documentation or actions) performed in the EHR beyond that which is essential for “good” clinical care.…”

Section: Introductionmentioning

confidence: 99%

“…In the last decade, studies examining ED clinician workflows and workload in the context of EHR use largely have been conducted outside the United States. 25–28 Concurrently, US-based research has predominately focused on the quantification of ED work using direct observation methods 9 , 10 , 13 , 14 , 29–32 and retrospective data analyses, 33–36 and on the use of surveys to assess ED clinician sentiment. 30 , 34 Qualitative research on ED clinician EHR use has examined overall satisfaction, the effect of EHR usability and policy on clinical workflows, 12 , 37 and their perceptions of EHR clinical documentation 10 , 11 ; however, these studies exclusively highlight physician experiences.…”

Section: Introductionmentioning

confidence: 99%

Understanding the perceived role of electronic health records and workflow fragmentation on clinician documentation burden in emergency departments

Moy

Hobensack

Marshall

et al. 2023

Journal of the American Medical Informatics Association

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Objective Understand the perceived role of electronic health records (EHR) and workflow fragmentation on clinician documentation burden in the emergency department (ED). Methods From February to June 2022, we conducted semistructured interviews among a national sample of US prescribing providers and registered nurses who actively practice in the adult ED setting and use Epic Systems’ EHR. We recruited participants through professional listservs, social media, and email invitations sent to healthcare professionals. We analyzed interview transcripts using inductive thematic analysis and interviewed participants until we achieved thematic saturation. We finalized themes through a consensus-building process. Results We conducted interviews with 12 prescribing providers and 12 registered nurses. Six themes were identified related to EHR factors perceived to contribute to documentation burden including lack of advanced EHR capabilities, absence of EHR optimization for clinicians, poor user interface design, hindered communication, increased manual work, and added workflow blockages, and five themes associated with cognitive load. Two themes emerged in the relationship between workflow fragmentation and EHR documentation burden: underlying sources and adverse consequences. Discussion Obtaining further stakeholder input and consensus is essential to determine whether these perceived burdensome EHR factors could be extended to broader contexts and addressed through optimizing existing EHR systems alone or through a broad overhaul of the EHR’s architecture and primary purpose. Conclusion While most clinicians perceived that the EHR added value to patient care and care quality, our findings underscore the importance of designing EHRs that are in harmony with ED clinical workflows to alleviate the clinician documentation burden.

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