Survey of clinical information system usage by paediatric intensive care units in the UK

Abstract

Dear Editor, The use of clinical information systems (CIS) and electronic prescribing have been shown in single centre studies to improve access to vital data, enhance patient safety and reduce manual documentation time in critical care [1, 2]. There are few large-scale reports of CIS utilisation in paediatric intensive care units (PICU). As part of the Informatics subgroup of the UK Paediatric Intensive Care Society, we conducted a national survey to study the distribution, characteristics and satisfaction with existing electronic systems. Lead intensivists, nurses and/or data managers from the Paediatric Intensive Care Audit Network (PICANet) [3] were invited to complete a self-administered questionnaire survey in September 2007, either online (QuestionPro, http://www. questionpro.com), on an emailed portable document format (PDF) form or on paper. Questions focused on: (a) use of hospital-wide electronic systems; (b) clinical functionality available in PICU systems; (c) data security; (d) research and audit; (e) user satisfaction measured on a Likert scale (1, very satisfied; 5, very dissatisfied); and (f) future plans for CIS implementation. Data were analysed at the unit level, except satisfaction scores, which were analysed at the respondent level. Characteristics of participating units (admission numbers, number of beds and unit type) were obtained from PICANet. Group-wise differences were analysed by using the chi-square test; Wilcoxon sign rank test was used for satisfaction scores. Fifty respondents from 28 out of 32 UK PICUs completed the survey (response rate 88%). Intensivists and nurses comprised the majority of subjects (62%). One-third of the units admitted more than 500 patients/ year, the majority being combined medical-surgical units. More than 80% of the units used hospital-wide systems for patient admission/discharge, radiology and laboratory results. In addition, units used a mixture of small locally developed (16/28) and commercial databases (8/28) with widely varying clinical functionality. Only one unit had gone ‘‘paperless’’ by implementing an integrated CIS with charting, clinical documentation and prescribing functions. In general, larger units were more likely to adopt more functional, commercial systems rather than ‘‘home-grown’’ databases (p \ 0.05). Clinical functionality provided by the various PICU systems is summarised in Table 1. In addition to clinical systems, a number of separate research and audit databases were also used to store data on specific patient groups (e.g. sepsis or extracorporeal membrane oxygenation) resulting in significant duplication of data entry and storage. No significant differences were seen between satisfaction levels of doctors and nurses, although ‘‘home-grown’’, less functional systems scored marginally higher satisfaction levels than commercially procured systems (median 2.5 vs. 2.0). Nevertheless, 5 PICUs reported plans to procure fully functional CIS within a year of the survey. Our study demonstrates poor uptake of CIS in UK PICUs, with larger units more likely to invest in clinical systems and smaller units