Date Available

4-29-2025

Year of Publication

2025

Document Type

DNP Project

Degree Name

Doctor of Nursing Practice

College

Nursing

Department/School/Program

Nursing

Faculty

Dr. Julie Marfell

Committee Member

Dr. Kristen Makowski

Faculty

Dr. Elizabeth Tovar

Abstract

Abstract

Background: The volume of Electronic Medical Records (EMR) messages from patients to providers continues to rise, yet clinic workflows have not been adequately restructured to accommodate. Increased EMR, especially the inbasket, is associated with provider burnout and decreased job satisfaction, contributing to provider turnover.

Purpose: To improve the triage and distribution of the EMR messaging workload

Method: A Nurse Triage Flowchart was implemented in the Gastroenterology Clinic at the University of Kentucky to help RNs/MAs triage patient messages for improved workflow. Surveys were completed by RNs/MAs and providers before and three months post-implementation. Data from EPIC over six months (three months pre- and post-implementation) was analyzed for message routing, provider workload, and response time.

Results: The GI clinic included 14 RNs/MAs and 29 providers. Among RNs/MAs, perceived adequacy of triage direction improved (7.0 to 8.1, p = 0.37), satisfaction increased (7.3 to 8.6, p = 0.21), and feelings of being overwhelmed slightly decreased (5.4 to 5.0, p = 0.78). All RNs/MAs found the flowchart helpful. Among providers, feelings of being overwhelmed decreased (7.7 to 6.8, p = 0.26). However, time spent on messages outside work and proportion of messages deemed answerable by other staff remained unchanged. (5.9 to 6.0, p = 0.94; 6.3 to 6.3, p = 1.0). Message forwarding to providers decreased in the final month (August–October: 28.72%, 23.62%, 25.54%; November–January: 25.82%, 25.61%, 21.7%). Forty-seven percent of providers perceived reduced message volume. Message distribution was uneven, with APPs and female providers receiving higher volumes. Response time to patients was unchanged.

Conclusion: The flowchart improved direction and satisfaction for RNs/MAs, enhancing autonomy. Overall workload impact for providers was minimal. Disparities in message distribution highlight need for further evaluation of workflow efficiency and equity.

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