Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Joseph F. Burkard, DNSc, CRNA, Chairperson; Jonathan Mack, PhD, NP; Michael Casale, PhD


Antibiotic Timeliness, hyperglycemia contro, Electronic Health Records, Electronic Medical Records, Intensive Care Unit, Mortality and length of stay, Quality outcomes


Purpose: The purpose of this retrospective pre and post descriptive study is to examine how EHR systemic implementation impacts the quality outcomes of the intensive care unit.

Background: EHR can improve safety and quality through communication, automation, streamlines and evidence based decision support. There is a limited body of knowledge and inconsistency about EHR impact on patients’ care outcomes and its effect on quality in intensive care settings.

Methods: We utilized Donabedian Triad model of structure, process and outcome to evaluate the significant change in the ICU outcomes. APACHE IV was used to measure severity of illness and predict length of stay and mortality. Data collection obtained through chart review abstraction tool.

Results: We explored the following five ICU quality outcomes: (a) Antibiotic Timelines; there was a significant decrease in the antibiotic timeliness before EHR implementation (M= 156, SD= 87) and antibiotic timeliness after EHR implementation (M=97, SD=83), p = 0.00, (b) Hyperglycemia control; there was significant improvement in hyperglycemia control for all patients Post EHR at a rate of 70%, 95% CI [69.9, 70.2] compared to pre EHR group at 54%, 95% CI [53.9, 54.2], p=0.00. There was also significant improvement in hyperglycemia control for the diabetic patients’ post EHR at 58%, 95% CI [57.7, 58.3], compared to Pre EHR at 44%, 95% CI [ 43.8, 44.2] p=0.012, (c) ICU length of stay; there was no significant difference in the mean Relative stay index(RSI) before EHR implementation (M= 0.89, SD=0. 09) and RSI after EHR implementation (M=0.86, SD=0.07), p = 0.75, (d) Mortality; there was a decrease in the standardized mortality ratio at 1.17 for post EHR compared to 1.38 for pre EHR, the excess death rate was significantly lower post EHR at 17%, 95% CI [16.7%,17.3%] compared to Pre EHR at 38%, 95% CI [16.7%,17.3%], p=0.01, (e) medication errors; there was no significant difference in the rate of medication errors between both periods, Pre EHR period rate was 3.5%, 95% CI [2.4%,4.6%] compared to 2.9%, 95% CI [1.9%,3.9%] for post EHR, p=.37.

Conclusion: EHR implementation and utilization had a significant positive impact on antibiotic timeliness, hyperglycemia control and mortality. However; Despite the decrease in the mean relative stay index and the rate of medication errors after EHR implementation; this decrease was statistically not significant. The study informs nursing practice and policy makers of the importance of EHR effective utilization and optimization.

Document Type

Dissertation: USD Users Only