Title : Improving T&O team confidence in using cerner following transition from paper-based records: A closed-loop two-cycle audit
Abstract:
Background: Princess Alexandra Hospital NHS Trust introduced Cerner, replacing previous systems for clinical documentation, prescribing and outpatient services. Variable staff fluency and system dysfunctionality during this transition risked delays, near misses and misses compromising patient safety within the Trauma & Orthopaedics (T&O) team.
Aim: To assess T&O team members' confidence in performing role-specific tasks on Cerner, identify training gaps and system faults, implement a targeted intervention, and re-evaluate confidence following this intervention.
Method: A role-specific questionnaire (three sections: registrars/consultants; SHOs/FY1s/FY2s; trauma co-ordinators) rated confidence (1–5 Likert scale) across tasks including requesting procedures/investigations, documenting operative notes, clerking and ward-round notes, generating patient lists, and booking outpatient follow-ups. Cycle 1 (n=19) identified confidence gaps and system faults, which informed a concise step-by-step quick-reference guide circulated to all team members, alongside feedback to the IT department. Cycle 2 (n=15) re-surveyed the same domains post-intervention.
Results: Cycle 1 showed low-to-moderate confidence across most tasks, notably OP follow-up clinic booking among SHOs/FY1s/FY2s (0% rating ≥4/5) and biopsy/sample-request confidence among registrars/consultants (11.1% rating ≥4/5). Following the intervention, high-confidence ratings (≥4/5) rose across nearly all tasks and grades: OP follow-up booking confidence among SHOs/FY1s/FY2s rose from 0% to 75%, investigation-requesting confidence from 63.6% to 100%, operative note documentation confidence among registrars/consultants from 44.4% to 100%, and OP clinic management confidence from 33.3% to 80%. Free-text feedback consistently described the guide as helpful and confidence-building.
Conclusion: A brief, role-tailored quick-reference guide combined with structured IT feedback produced a substantial, measurable improvement in self-reported staff confidence using Cerner across all T&O grades. This low-cost, scalable intervention supports patient safety during electronic-record transitions and should be sustained via a shared-drive FAQ resource, ongoing IT liaison, and Datix reporting of any system-related safety incidents. Limitations include reliance on self-reported (rather than observed) competence and a smaller respondent pool at re-audit (n=15 vs n=19).
