What’s a tri-fold?


McGee, E. (Fall, 2017). Student Editorial: What’s a tri-fold? Online Journal of Nursing Informatics (OJNI), 21(3), Available at http://www.himss.org/ojni

Editorial Overview

This is a short editorial that was written as an assignment for an Informatics and Healthcare Technology course as I work towards obtaining my Master’s of Science in Nursing.  We were asked to write an editorial about an experience that we have had as a nurse utilizing technology in the field.  Mine is an overview of a night when our electronic medical record (EMR) went down and did not come up as scheduled.


The night shift is when the hospital sleeps, right?  This must be why the electronic medical record (EMR) downtime always occurs at one o’clock in the morning, because what could we possibly have to chart at this hour in the morning? Vital signs, mid-night assessments that are just getting done, and medications that need to be administered are just a few items that come to mind.  It was a relatively busy evening when the off-going charge nurse reminded the staff that we had a scheduled downtime during our shift.  “It should be back up and running by five o’clock in the morning, so you will have plenty of time to back chart the care that you provided.  If it doesn’t come back up just pull out the old tri-fold” she said as she headed down the hall. 

As soon as I turned back to the nurse’s station, I saw the look of terror on the faces of a couple of our newer team members and I knew that they had no idea what a tri-fold was.  Gone are the days of opening up the paper chart for our laboring patients that we referred to as the “tri-fold”, well because it folded three times.  It was organized in rows and columns with times across the top and possible events down the side; it was easy to follow with a key at the top for abbreviations to be used.  It was not uncommon to see a nurse at the desk after her delivery with the tri-fold open and the fetal monitoring strip below it, filling in the events of labor that had occurred while she was busy providing support to her laboring patient.  The nurses that have been hired within the last twelve years have never had to use a pen to chart on their laboring patients: they have always relied on a mouse and keyboard to scroll through the fetal monitoring strip and check the boxes that correlate with events on their screens.

I took a few moments to explain this “archaic” practice of charting to the nurses who were staring at me like deer in headlights, and then finished by remarking that there was no way the system would be down long enough to require us to dust off the paper charts.  Five o’clock a.m. came and went and when the system was not back up at six o’clock we knew that it was time to dig out the old tri-folds and grab a pen to start charting before the next shift came on.  Luckily, the tri-fold was organized much like our EMR and the nurses caught on quick.  They were amazed with how quickly they were able to chart the care that they had provided over the course of the previous five hours, and even expressed their appreciation for the fact that we had built our EMR to reflect these original flow charts. 

The system was up and running by the time we returned to work that night and the tri-folds had been tucked safely away in the storage closet, only to emerge during the next EMR emergency.  This entire experience was a great opportunity for us all to realize that we take our technology for granted and that patient charts may not always be just a click away.  It also made it clear that our new nurses deserve to have a look at the tri-fold during their orientation to save them all from the fear of the unknown that those nurses felt that evening as they heard of this potential need to chart on paper!

Author Bio:

My name is Emily McKee, I have been a nurse for fourteen years and have spent the majority of those years in the realm of Obstetrics.  I have been a clinical educator for the past five years at the college level and also within a multi-system organization for their two OB departments and a small pediatric department.  I obtained my Associates Degree in Nursing from Kellogg Community College in Battle Creek, Michigan, my Bachelor’s of Science in Nursing from Baker College in Flint, Michigan, and I am currently pursuing my Master’s of Science in Nursing from Baker College.  I am looking forward to continuing to teach our next generation of nursing at a higher level as a faculty member at a college.