Impact of the Electronic Medical Record on Nurse's Time Allocation During Cesarean Delivery [25R]

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The impact of the Electronic Medical Record (EMR) on provider workflow is not well understood. The objective of this study was to collect data on the time that nurses spend on the EMR in the operating room (OR) during cesarean deliveries.


From June–July 2015, 20 scheduled cesarean deliveries were observed in the Labor & Delivery ORs at Lucile Packard Children's Hospital at Stanford, California. An observer timed how long the circulating nurse spent on the EMR during the case. Immediately after delivery, the nurse completed a questionnaire to determine perception of time allotted to various activities pre-, intra-, and post-operatively. They were also asked about time allocation during the last cesarean, and their desired time allocation.


Mean±SD time nurses spent on the EMR was 36±12 minutes per case; 40% ±10% of the duration of the cesarean delivery. Nurses tended to exaggerate time spent on the EMR; the reported 55% proportion of time spent on EMR was greater than the actual timed EMR value of 40% (P=.020). There was no difference in the nurse's reported average time spent on EMR pre-, intra- and postoperatively (P=.511). Nurse's reported optimal amount of time spent on the EMR was 22% ±15%, significantly less than reported time spent on the EMR (P=.007).


EMR time burden is perceived by nurses to be demanding and onerous. Future studies are needed to better understand impacts of intra-operative EMR on patient safety and how EMR can be optimized to limit time requirements.

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