Nurses at Sacramento, Calif.-based Sutter Health used to document every time a patient was watching TV or on their phones. No longer.
In fact, the 27-hospital system has saved nurses 400,000 EHR clicks a day, the equivalent of 110 hours, by streamlining its Epic workflows. Now nurses only note exceptional or abnormal findings in a patient’s chart.
“We couldn’t find any organization that had done that … we were forging ahead as a new frontier,” Fiona Dennison, BSN, RN, director of nursing informatics at Sutter Health, told Becker’s. “Staff were coming up at the end saying thank you for hearing us and letting us decide what we’re going to document.”
The health system started implementing Epic by region in 2014, planning to optimize the workflows once it was done. That didn’t really happen. Nurses complained of duplicative, redundant documentation often not pertaining to healthcare (like TV-watching). Sutter Health was in Epic’s bottom 25th percentile for time spent in the EHR; satisfaction scores measured by KLAS Research were in the low 40s (out of 100).
Then new leadership came aboard and took a fresh look at the problem.
“I joined in 2023 and they were like, ‘Can we please do this project?'” said Laura Wilt, senior vice president and chief digital officer of Sutter Health. “I was new, so I was like, ‘Of course, we should definitely do this project.’ And I’m so glad that we did, but it really was a huge undertaking because of the way they engaged the front-line nurses in it.”
After years of ineffectual documentation, they were happy to be engaged. The informatics team led classroom training for about 12,000 nurses, who rated the course a 4.5/5. Sutter Health went live with Nursing FOCUS in February, starting with med-surg, ICU, pediatrics and PICU (FOCUS stands for Flowsheet Optimization and Care Plan Updates to Simplify Documentation).
Nurse EHR satisfaction scores jumped past 60, the biggest increase in such a brief span on record for KLAS. Flowsheet documentation dropped by 24%. Clicks are down 20%. Nurses’ incremental overtime — staying 15-or-so minutes past their shift to finish charting — fell by 21%. In surgical units, 21 pages of documentation became two.
“The approach and the adoption and the just very dramatic improvements are pretty unique,” Ms. Wilt said. “This project really is giving nurses time back at the bedside.”
She endearingly calls the staffers who helped build and champion the tool “influencers.”
Nurses no longer have to document “normal values,” like a patient breathing properly. “Without the ‘normals,’ the flow sheets look beautiful, because when you look at them, you just see what is wrong with the patient,” Ms. Dennison said. She calls it “documenting by exception.”
The health system also moved to Epic’s foundational flow sheet, care plan and educational platforms. Care plans are now based more on physiology than diagnosis, aligning them more with what nurses actually assess. About 15 nursing informaticists and five IT analysts worked full time on the project for eight months.
Other health systems — and even Epic — have reached out to Sutter Health to learn more. Nursing FOCUS continues to expand, going live recently in respiratory therapy and ASCs with behavioral health, NICU and OB to follow.
“It has been a huge boost for front-line nurses to see that their feedback has been received and that they’ve actually had an impact systemwide,” Ms. Wilt said. “We’re really on a multiyear journey to transform the organization digitally. I don’t think it’s going to be one and done.”
