EHR Documentation Frequency Changes Across the COVID-19 Pandemic

Abstract

Documentation is crucial for patient care. However, the increased documentation burden raises questions about its clinical value. The COVID-19 pandemic provided an opportunity to explore nurses' documentation patterns due to increased patient care demands and the implementation of documentation relaxation policy. We conducted a trend analysis to examine documentation frequency over time, including phases during the pandemic and the implementation of the Surge Documentation, a documentation relaxation policy at a Midwest academic medical center. We analyzed the trend changes using segmented regression and mixed-effect Poisson regression. We found that documentation frequency increased in response to the pandemic due to the heightened demand for patient care and significantly decreased with the implementation of Surge documentation. The reduction was particularly noticeable in flowsheets unrelated to patient acuity. The study highlighted nurses' critical thinking in prioritizing documentation based on patient care. Future policies should support nurses'autonomy in documentation without imposing excessive requirements.

Keywords: Data Mining; Documentation Burden; Nursing Informatics; Trend Analysis.

Figure 1.

Study Phases and the Pipeline of Trend Changes in Nursing Flowsheet Documentation. a) Study phases and the timelines for Surge Documentation implementations (Surge Doc) Phases One & Two. b) The pipeline of the trend analysis. c) The illustrations of the segmentation regression. Model 1, COVID-19 phases; Model 2, Surge Doc Phases. d) The factors in the mixed-effect Poisson regression model.

Figure 2.

Slope Changes for the Flowsheet Measure Documentation Groups in Acute Care Units.

Figure 3.

Relative Risks with 95% Confidence Intervals for time and other Factors Influencing Documentation Trends. Surg Doc, Surge Documentation. CCI, Charlson Comorbidity Index.