Data collected by the electronic health record is insufficient for estimating nursing costs: An observational study on acute care inpatient nursing units

Introduction As the electronic health record becomes more sophisticated, commensurate advances in cost accounting have risen as a top priority for hospital leaders. This study explored: 1) the average time to complete common nursing tasks documented in the electronic health record, 2) nursing-related tasks that remain undocumented, 3) the association between observation data and actual nursing documentation, and 4) considerations for model development and report design to be used for activity based cost accounting in nursing. Methods This was an observational study completed on acute care inpatient nursing units at a large academic medical center. During a five-week period, 63 nurses from 25 units were observed for over 250 h. Results Nearly 60% of the observed nursing activities did not fit into categories readily available in, and easily abstracted from, the electronic health record. The undocumented activities accounted for over half of the observation tasks and equated to nearly 130 h, in which over 40 h were spent on the activity of documentation/charting itself. Furthermore, nearly 36 h were spent on communication, followed by 13.5 h on monitoring/surveillance, two critical tasks in nursing which cannot be overlooked. Conclusions Using the electronic health record for cost accounting in nursing is a novel approach. In addition to the electronic health record, supplementary sources of data must be included to accurately capture nursing work and associated costs. Findings and lessons learned from this study will be used to guide future work and develop a model that determines the cost of nursing care and improved value in hospitalized patients. (C) 2019 Elsevier Ltd. All rights reserved.