The Impact of Electronic Medical Record Implementation on the Process and Outcomes of Nursing Handover: A Rapid Evidence Assessment

Abstract

This Rapid Evidence Assessment (REA) aimed to investigate the impact of electronic medical record (EMR) implementation on the process and outcomes of nursing handover by synthesising the existing scientific literature. Clinical nursing handover involves transferring patient information, responsibility and accountability to ensure continuity of care and patient safety. Poor or absent clinical handover can negatively impact quality of care, patient safety and patient outcomes. EMRs are patient information systems that facilitate the real-time sharing of patient data. It has been proposed that EMRs may assist in addressing communication issues often associated with poor nursing handover, yet the implementation and impact of EMR implementations remain varied. A database search was conducted in PubMed, CINAHL and Cochrane. Articles for inclusion were studies in which the impact of an EMR implementation was evaluated, where participants were nurses performing handover from shift to shift in a hospital setting. Eleven studies from 4 different countries were included. The study findings revealed 4 broad themes that serve to answer the research question: use of the EMR during handover; nurse perceptions and satisfaction with the EMR; barriers to use; and enablers to use. EMR-mediated handover was described in 7 studies. EMR-structured handover was described in 7 studies. EMR-generated printouts were described in 4 studies. While the EMR was routinely used to validate and check certain pieces of information during handover, nurses considered their personalised paper-based forms to be the preferred handover tool. The main findings were that nurses generally expressed dissatisfaction with using the EMR to facilitate handover, with three studies reported dissatisfaction with EMR-based handover. 50% of nurses found printouts cumbersome, and 69% reported irrelevant information. Barriers to EMR use included 6 studies that identified design-related barriers. 4 studies emphasised the importance of cognitive support and situational awareness. 4 studies highlighted the lack of nursing engagement and codesign. 5 studies discussed variations in nurse digital literacy. Enablers to EMR use included two studies highlighting the importance of nurse engagement and codesign in successful EMR-facilitated handover. Three studies showed nurses deliberately adopting EMR-based handover tools, contrasting with previous examples of forced adaptation. No single tool was able to provide nurses with the whole patient story, the required situational awareness, nor the cognitive support required to convey and receive information during handover. An effective EMR-mediated solution that improves the efficacy and quality of nursing handover has not yet been realised. Future efforts to design EMR-mediated solutions to better support nurses must fully appreciate the complexities of nursing handover, the mental workload associated with the task and the definitive qualities of tools to provide this support. This REA has demonstrated the need for clinical nurses to be more directly involved in the iterative development and evaluation of these tools in order to specifically enhance processes and outcomes of nursing handover.