Becker's Clinical Quality & Infection Control

20 Executive Briefing The Greeley Company is a full-service healthcare consulting practice with specialties including Compliance & Bylaws, Credentialing & Privileging, Physician-Hospital Alignment, Medical Staff Optimization, External Peer Review, Interim Leadership Staffing, and Onsite Education & National Seminars. Call Greeley today at 888-749-3054. expected to evaluate the patient every two hours, most hos- pitals require concurrent documentation. With up to 30 data points required by most hospitals every two hours, the result is 120 data points for every 8-hour shift. Greeley has successfully transitioned several clients to an attestation statement that includes all required data elements, but instead of concurrent documentation, the statement is completed at the end of the shift. The distillation of 120 data elements to a fully compliant single entry gets nurses back to patient-facing productivity. The Greeley Company's consultants are physicians and nurses who not only have a deep understanding of the regulations, but also understand clinical process and workflow. This allows them to help hospital leaders understand which parts of the documentation process are unnecessary and point out the consequences of inefficiencies. "If a clinical process isn't practical and efficient, clinicians will find a way around it," emphasizes Mr. Bryant. "Clinicians want to do what's right and in their patient's best interests. If 100- plus clicks and entries don't make clinical sense to them, it's not a sustainable process. An effective process must be one that drives quality and safety, but it also has to be efficient enough to be sustainable. Instead of 100 clicks, how about something they can do 100 percent of the time for an entire patient population?" When hospitals enlist The Greeley Company to help them sim- plify their documentation processes, consultants first conduct a current-to-future state assessment. This assessment typically takes less than a week. The goal is to identify and quantify the clinical documentation reduction opportunities, and help the client better understand the Greeley methodology for simpli- fication. The overall aim is to align a hospital's documentation processes, policies and clinician workflows, which Mr. Bryant notes is not easy, but very worth the investment. In one success story, The Greeley Company worked with a Mid-Atlantic hospital to reduce the number of data entries clini- cians input into their EHR. Greeley consultants found opportu- nities to reduce the admission assessment from 387 elements to 55 elements. On average, Greeley can reduce clinical entries into a hospital EHR by 70 percent. How lowering EHR entries impacts the nurse's role The role of a nurse has shifted dramatically over the years with the proliferation of the EHR. Gone are the Kardex and nursing notes -- two very valuable communication vehicles that physi- cians valued, according to Mr. Bryant. The EHR has effectively transitioned the nurse from a critical thinker to a task oriented resource. "We need to trust in our clinicians and listen to them," Mr. Bryant says. "Nurses have critical thinking skills, and we have to remember nursing notes can be a vital, organic form of communication. If nurses are checking duplicative boxes all day, they have less time to make the observations doctors have come to trust." The Greeley Company surveyed nurses from several different facilities before and after Greeley's simplification recommenda- tions were implemented. Some notable findings include: • 82 percent improvement in "Information is rarely duplicat- ed in the EMR/medical record." • 48 percent improvement in "I feel that the care I give is always reflected in the medical record." • 55 percent improvement in "I can look at the EMR and get a clear story of why my patient is in the hospital." Simplifying the process empowers clinicians to focus on patient care Every hospital can benefit from improving efficiencies in the documentation process. Most importantly, efficient documenta- tion enables clinicians to spend more time making eye contact with patients and less time looking at screens. "When a physician looks a patient in the eye and understands their concerns, a patient feels safe and will likely report higher satisfaction. If a clinician is running back to the EHR to input information, or worse, looking at a device or screen during a patient interaction, a patient may feel neglected and less in- cluded in their care decisions," says Mr. Bryant. "These erosions of the physician-patient relationship can be avoided through simplifying the documentation process, alleviating the admin- istrative burden on practitioners, preserving (and restoring) the doctor-patient relationship, and reducing clinician frustration and burnout rates." "Doctors and caregivers don't choose careers in medicine to perfect their data entry skills," Mr. Bryant adds. "Greeley spe- cializes in distilling the required and finding the essential – sim- plifying the complex aspects of documentation and bringing reasonability back. These efforts at efficiency and practicality work to get doctors and nurses back to the bedside." n

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