Acute Care Surgeons Spend More Time than General Surgeons on the Electronic Health Record (EHR).

BACKGROUND: The paradigm of Acute Care Surgery (ACS) emerged in response to decreasing operative opportunities for trauma surgeons and increasing need for surgical coverage in disciplines to which the expertise of trauma surgeons naturally extends. While the continued evolution of this specialty remains largely beneficial, unintended consequences may have arisen along the way. One aspect of ACS that remains to be thoroughly investigated is the impact of the electronic health record (EHR). The purpose of this study is to objectively quantify EHR usage for ACS and compare it to other general surgery specialties. METHODS: EHR user data were collected for fifteen ACS attendings and thirty-seven general surgery attendings from October 2014 to September 2019. Comparative analysis was conducted using two-tailed t-tests. Subgroup analysis was conducted for subspecialties included in the general surgery group. RESULTS: ACS attendings opened almost 3 times as many charts as general surgery attendings per month (180 vs 64 charts/month, P < .0001), and ultimately spent more time on the EHR as a result (10 vs 6.4 hours/month, P < .0001). Documentation was the most time consuming EHR task for both groups. Although ACS attendings spent less overall time per patient chart, the proportion of time spent on certain EHR tasks was similar to that of general surgery colleagues. DISCUSSION: The EHR imposes a disproportionate burden on ACS attendings compared to their general surgery counterparts, and additional study is warranted to improve usage. EHR usage burden has workforce implications for trainees considering a career in ACS.

Improving enteral nutrition delivery in the critically ill trauma and surgical population.

BACKGROUND: Critically ill trauma and surgical patients often fail to achieve adequate enteral nutrition (EN) support. We hypothesize that implementation of an evidence-based, multidisciplinary nutrition enhancement protocol (EP) will improve delivery of EN in critically ill trauma and surgical patients and align our institution with nationally recommended guidelines. METHODS: The study compared patients prior to protocol (PP) with patients after implementation of the EP. The primary outcome was delivery of >80% of daily prescribed EN kilocalories in critically ill trauma and surgical patients during their intensive care unit stay. Data were prospectively captured from daily rounds and the electronic health record. Statistical analysis was conducted to compare data between groups using Student t test for continuous variables and chi-square test for categorical variables. RESULTS: In total, 256 patients in the PP group (2663 EN days) were compared with 232 patients in the EP group (2059 EN days). The primary outcome of average percentage of nutrition delivered (based on 24-h kilocalorie requirements) improved after the implementation of the EP (75.3% PP vs 85.5% EP; P < 0.01). This improvement was evident in surgical (69.9% PP vs 78.7% EP; P < 0.01) and trauma (78.2% PP vs 87.3% EP; P < 0.01) subpopulations. The secondary outcome of percentage of patients receiving >80% of nutrition goal also improved (52.7% PP vs 65.2% EP; P < 0.01). CONCLUSION: Implementation of an EP significantly increased delivery of EN by 10.2% and achieved compliance with American Society for Parenteral and Enteral Nutrition and Society of Critical Care Medicine recommended guidelines for critically ill trauma and surgical patients.