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Electronic health records, Perioperative care, Task analysis, Video recording, Workflow



  1. Zheng, Lu MS, MHI, RN
  2. Kaufman, David R. PhD
  3. Duncan, Benjamin J. MS
  4. Furniss, Stephanie K. PhD
  5. Grando, Adela PhD
  6. Poterack, Karl A. MD
  7. Miksch, Timothy A. MBA
  8. Helmers, Richard A. MD
  9. Doebbeling, Bradley N. MD, MSc


Preoperative care is a critical, yet complex, time-sensitive process. Optimization of workflow is challenging for many reasons, including a lack of standard workflow analysis methods. We sought to comprehensively characterize electronic health record-mediated preoperative nursing workflow. We employed a structured methodological framework to investigate and explain variations in the workflow. Video recording software captured 10 preoperative cases at Arizona and Florida regional referral centers. We compared the distribution of work for electronic health record tasks and off-screen tasks through quantitative analysis. Suboptimal patterns and reasons for variation were explored through qualitative analysis. Although both settings used the same electronic health record system, electronic health record tasks and off-screen tasks time distribution and patterns were notably different across two sites. Arizona nurses spent a longer time completing preoperative assessment. Electronic health record tasks occupied a higher proportion of time in Arizona, while off-screen tasks occupied a higher proportion in Florida. The contextual analysis helped to identify the variation associated with the documentation workload, preparation of the patient, and regional differences. These findings should seed hypotheses for future optimization efforts and research supporting standardization and harmonization of workflow across settings, post-electronic health record conversion.