Abstract

BackgroundElectronic documentation handling may facilitate information flows in health care settings to support better coordination of care among Health Care Providers (HCPs), but evidence is limited. Methods that accurately depict changes to the workflows of HCPs are needed to assess whether the introduction of a Critical Care clinical Information System (CCIS) to two Intensive Care Units (ICUs) represents a positive step for patient care. To evaluate a previously described method of quantifying amounts of time spent and interruptions encountered by HCPs working in two ICUs.MethodsObservers used PDAs running the Work Observation Method By Activity Timing (WOMBAT) software to record the tasks performed by HCPs in advance of the introduction of a Critical Care clinical Information System (CCIS) to quantify amounts of time spent on tasks and interruptions encountered by HCPs in ICUs.ResultsWe report the percentages of time spent on each task category, and the rates of interruptions observed for physicians, nurses, respiratory therapists, and unit clerks. Compared with previously published data from Australian hospital wards, interdisciplinary information sharing and communication in ICUs explain higher proportions of time spent on professional communication and documentation by nurses and physicians, as well as more frequent interruptions which are often followed by professional communication tasks.ConclusionsCritical care workloads include requirements for timely information sharing and communication and explain the differences we observed between the two datasets. The data presented here further validate the WOMBAT method, and support plans to compare workflows before and after the introduction of electronic documentation methods in ICUs.

Highlights

  • Electronic documentation handling may facilitate information flows in health care settings to support better coordination of care among Health Care Providers (HCPs), but evidence is limited

  • An electronic medical record designed for the Intensive Care Units (ICUs) environment, a Critical Care clinical Information System (CCIS), can automate some transcription tasks and aid in informational continuity between HCPs [5]

  • ICU physicians, nurses, respiratory therapists and unit clerks were observed for 58 hours, 62, 55, and 57 hours respectively

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Summary

Introduction

Electronic documentation handling may facilitate information flows in health care settings to support better coordination of care among Health Care Providers (HCPs), but evidence is limited. HCPs use diverse information sources to prioritize their tasks and make decisions about patient care. These sources include other HCPs, bedside equipment, and laboratories located at some distance from the patient [1,2,3]. With paper charts in place, HCPs transcribe information from bedside equipment and laboratory reports. Transcribing information into patient charts may not be the best use of time for highly specialized and expensive HCPs. An electronic medical record designed for the ICU environment, a Critical Care clinical Information System (CCIS), can automate some transcription tasks and aid in informational continuity between HCPs [5]. High rates of failure have been reported for many electronic systems in healthcare, in which organizations have either adopted other systems or reverted to paper charts [8,9]

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