Impact of institution of an electronic hospital information system on nursing quick registration and triage times

Abstract

Study objectives: Emergency departments (EDs) are increasingly using electronic information systems for patient tracking and documentation. However, their impact on ED efficiency has not been well described. We seek to determine the effect of switching from a paper system to an electronic system on the time required for the quick registration and triage of patients. Methods: The study design was a prospective observational work analysis using time and motion technique. Staff nurses were observed in the dedicated triage area of a public teaching hospital ED. Time to complete a patient quick registration or triage was recorded by 2 observers during the period before and 15 months after the implementation of electronic charting. Multiple nurses were observed, and no single nurse was observed for more than 5 consecutive patient quick registrations or triages. Results: A total of 57 paper quick registrations and 56 paper triage times and a total of 45 electronic quick registrations and 70 electronic triage times were observed. The mean times required were as follows: paper quick registration, 125 seconds (95% confidence interval [CI] 108.5 to 141.9 seconds); electronic quick registration, 165 seconds (95% CI 135.7 to 194.6 seconds); paper triages, 267 seconds (95% CI 233.2 to 301.0 seconds); electronic triages 364 seconds (95% CI 325.2 to 364.4 seconds). Electronic quick registration times were not significantly different, but electronic triage times were longer by an average of 97 seconds per patient. At our current census of 130,000 patients, this equates to an increase of 3,502 nursing work-hours per year, which would require the hiring of 2.0 more nurses. Conclusion: Institution of an electronic information system significantly increases triage times. This increase may require nurse staffing adjustments. Study objectives: Emergency departments (EDs) are increasingly using electronic information systems for patient tracking and documentation. However, their impact on ED efficiency has not been well described. We seek to determine the effect of switching from a paper system to an electronic system on the time required for the quick registration and triage of patients. Methods: The study design was a prospective observational work analysis using time and motion technique. Staff nurses were observed in the dedicated triage area of a public teaching hospital ED. Time to complete a patient quick registration or triage was recorded by 2 observers during the period before and 15 months after the implementation of electronic charting. Multiple nurses were observed, and no single nurse was observed for more than 5 consecutive patient quick registrations or triages. Results: A total of 57 paper quick registrations and 56 paper triage times and a total of 45 electronic quick registrations and 70 electronic triage times were observed. The mean times required were as follows: paper quick registration, 125 seconds (95% confidence interval [CI] 108.5 to 141.9 seconds); electronic quick registration, 165 seconds (95% CI 135.7 to 194.6 seconds); paper triages, 267 seconds (95% CI 233.2 to 301.0 seconds); electronic triages 364 seconds (95% CI 325.2 to 364.4 seconds). Electronic quick registration times were not significantly different, but electronic triage times were longer by an average of 97 seconds per patient. At our current census of 130,000 patients, this equates to an increase of 3,502 nursing work-hours per year, which would require the hiring of 2.0 more nurses. Conclusion: Institution of an electronic information system significantly increases triage times. This increase may require nurse staffing adjustments.