Abstract
Introduction
Recent literature has sought to quantify pre-operative work associated with total joint arthroplasty. These studies have utilized surveys or self-reported time logs to estimate the Pre-op Optimization Work (POW) completed by the surgical team. The purpose of this study was to objectively quantify POW associated with total hip arthroplasty (THA) using electronic medical record (EMR) activity audit logs.
Methods
Retrospective analysis of EMR activity for 4 arthroplasty surgeons and their clinical staff was collected for 100 consecutive THA cases (25 per surgeon). Clinical informatics data was generated using EMR activity audit logs for pre-THA activity. Every action and mouse-click within a patient's chart was recorded for each team member. The time between mouse-clicks was calculated and summed for each user. Times exceeding five minutes without activity were assumed to reflect inactivity and excluded. Descriptive statistics were used to estimate the POW associated with THA preparation.
Results
The mean number of days for pre-THA time period was70.7 (SD43.9; range: 8–175days). During this period, the mean time spent in each patient's chart was 75.5 minutes (SD50.75) minutes. Surgeon's POW in the medical record accounted for 7.3(SD6.7) of these minutes. Much of the work was conducted by nurses (47.0 minutes, SD43.4), physician extenders (10.8 minutes, SD 13.1), and qualified office staff/technicians (10.4 minutes, SD14.9). The majority of work captured in the EMR activity log was associated with medication review, patient optimization, documentation of necessary medical clearances, ordersets, patient communication, and prior authorization requests.
Conclusion
A considerable amount of preoperative work is required between the clinic date a patient decides to pursue THA and the day prior to surgery. These retrospective electronic time stamp measurements should represent the absolute minimum time required for surgical preparation.
