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Education, Teaching, and Quality Improvement |

Electronic Medical Record and Communication in the Hospital

Stephanie Taylor, MD; Brice Taylor, MD; Robert Ledford, MD; Erika Abel, MD
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University of South Florida, Tampa, FL


Chest. 2013;144(4_MeetingAbstracts):577A. doi:10.1378/chest.1702090
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Abstract

SESSION TITLE: Quality Innovation, Transformation and Design Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Increasing attention is being given to the importance of communication in the delivery of high-quality healthcare. One commonly identified solution to inadequate communication is the implementation of electronic medical record (EMR). We sought to determine whether communication improved in a hospital setting following the introduction of EMR.

METHODS: This cohort design occurred at a tertiary care, academic hospital. We enrolled 75 patient-nurse-physician triads prior to the introduction of EMR and 123 triads after the introduction EMR. Patients, nurses, and physicians answered several questions about the plan of care for the day. Responses were scored for degree of agreement and summed to obtain a Total Agreement Score. Nurses and patients answered questions about their communication with the physician that day.

RESULTS: Although there was no difference in the frequency of nurses reporting communication with physicians before and after EMR, face-to-face communication was significantly reduced after EMR (67% vs 51%, p = 0.02). There was no difference in the frequency of patients reporting communication with physicians before and after EMR. Total Agreement Score was significantly lower after the implementation of EMR (p = 0.03). Patients were also less likely to accurately estimate their expected length of stay after EMR (p < 0.01). Lack of face-to-face communication between the physician and nurse was an independent predictor of 30-day readmission (OR 2.15, 95% CI:1.03-4.48, p = 0.04).

CONCLUSIONS: The implementation of EMR was associated with a decrease in face-to-face communication between physicians and nurses and worsened agreement about the plan of care. Lack of face-to-face communication was associated with an increased risk of 30-day readmission.

CLINICAL IMPLICATIONS: Although EMR provides advantages through enhanced information sharing, the importance of preserving interpersonal communication is demonstrated by this study. Efforts toward communication skills training and the modification of clinical workflows in the setting of EMR are necessary to facilitate quality communication.

DISCLOSURE: The following authors have nothing to disclose: Stephanie Taylor, Brice Taylor, Robert Ledford, Erika Abel

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