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UPMC Quality Improvement Project Incorporates Patient Perspective to Analyze Nursing Activity

PITTSBURGH, Nov. 15, 2016 – As the role of technology continues to grow in the health care industry, a unique UPMC quality improvement project coupled patient surveys with observations, nurses’ self-reports and electronic health record (EHR) data to better understand how nurses allocate their time during a shift.
 
The findings, recently published online in the Journal of Nursing Care Quality, are intended to help the health system take further steps to improve care quality and the patient experience.
 
“UPMC nurses had expressed concerns that they were spending too much time entering information into the EHR and not enough time at the bedside caring for patients,” said Linda Higgins, Ph.D., R.N., lead author of the project. “It also was unclear how patients felt about the time they spent with their nurses, so we designed this project to gather multi-faceted data that could provide a comprehensive picture of nursing activity and guide future improvements in workflow and patient satisfaction.”
 
Over five months, 11 trained observers visited four inpatient units, shadowing one shift for each of the 79 nurses involved in the project. The observers chronicled 900 hours of nursing activity and logged it according to predetermined categories. Following the observed shift, nurses filled out a questionnaire, and the observers interviewed the patients cared for by the observed nurses.
 
In the interviews, patients reported spending an average of 74 minutes with their assigned nurse, and 90 percent rated the amount of time with their nurse as “excellent” or “good.” Yet, the observers estimate that the nurses actually spent only about 40 minutes with each patient. This suggests that the quality of the time that nurses spend with their patients may impact the patients’ perceptions of the length of time their nurses spend with them.
 
The most frequently observed shift activities were: documenting in (11.5 percent) and reviewing (9.1 percent) the EHR; patient assessment and interaction (8.9 percent); in-person communications with health care workers about patients or patient care (7.5 percent); and patient care and bedside procedures (7.2 percent). Overall, nurses were observed to spend an average of 33 percent of their shift interacting with technology.
Other project findings indicate that nurses overestimated the time they spent directly caring for patients and charting in the EHR compared to observations. Nurses also reported mostly positive attitudes toward the EHR and other technology in terms of user experience.
 
“This project uncovered a discord between nurses’ self-reported and direct observations of how time is actually spent during a shift,” said Tami Minnier, UPMC’s chief quality officer. “With these findings in mind, we can better target changes that may improve the way our nurses work, while also boosting patient satisfaction and outcomes.”
 
Additional authors on this analysis were Judith A. Shovel, B.S.N., R.N., Andrew L. Bilderback, M.S., Holly L. Lorenz, M.S.N., R.N., Susan C. Martin, M.S.N., R.N., and Debra J. Rogers, B.S.N., R.N., all of UPMC. This project was funded by the Masimo Corporation and the University of Pittsburgh Health Policy Institute.

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