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Impact of computerized information systems on workload in operating room and intensive care unit

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The number of operating rooms and intensive care departments equipped with a clinical information system (CIS) is rapidly expanding. Amongst the putative advantages of such an installation, reduction in workload for the clinician is one of the most appealing. The scarce studies looking at workload variations associated with the implementation of a CIS, only focus on direct workload discarding indirect changes in workload. Descriptions of the various methods to quantify workload are provided.

The hypothesis that a third generation CIS can reduce documentation time for ICU nurses and increase time they spend on patient care, is supported by recent literature. Though it seems obvious to extrapolate these advantages of a CIS to the anesthesiology department or physicians in the intensive care, studies examining this assumption are scarce.

Introduction

Computerized information systems (CIS) for the anesthesia department and the intensive care unit have been around for several years. The initial homemade programs from the early eighties/nineties primarily collected data as captured by the bedside devices. The currently available systems have evolved into advanced record-keeping programs. Most of the systems are capable of not only collecting the available data and documenting the clinical course; in some instances the systems are making suggestions regarding patient management. This stage corresponds to the third generation of computer based patient records according to the classification scheme of Gartner cooperation.1 The Gartner cooperation envisions that the computer based patient records will evolve in the coming decennia from the current “helper” functionality through the “colleague” stage to reach “mentor” capabilities.

Amongst the general perceived advantages of computerizing the bedside is the reduction in the workload for the clinician, one of the most appealing. This reduction in workload will be embraced by the hospitals that are faced with an ongoing shortage of personnel in the critical care environment.2, 3, 4, 5 This chapter will focus on changes in workload induced by implementing a CIS in the operating room (OR) or the intensive care unit (ICU).

Section snippets

Workload

In order to measure workload, we have to define workload. In the scarce literature regarding CIS in the OR and ICU the most frequently used definition for workload is the amount of time spend performing certain predefined tasks.6 The vast majority of studies in the OR and the ICU interpret this as time needed for documentation and time spend in patient care. There are several restrictions to this limited view on workload: first of all it only considers time spend performing certain tasks and

Methodologies

In order to be able to measure changes in workload, several methodologies to evaluate the workload are available. The next part will discuss several of methods focused on the direct workload measurement in the workplace. We should realize that implementing computerized information systems in any ward has major consequences throughout the whole organization. On the one hand, the introduction of these kind of systems will create additional work (installation, maintenance, training, support) and

Review of literature

The Cochrane library currently holds only one record related to the subject of workload reduction with CIS, none of the studies enrolled in this review took place on OR or ICU.84 The most relevant literature looking at the differences in workload between paper registration and CIS in the OR or ICU are listed in Table 1.

Conclusion

Clinical information systems are rapidly conquering not only the OR and ICU but the whole hospital area as well. This battle wasn't won on items like reduction in workload, but especially on topics like error reduction, quality improvement and medico-legal aspects.13, 48, 52, 56, *58, 59, 61, 62, 63, 64, 66, 67, 68, 71, 87, 88 Currently, most CIS installations in OR and ICU still work as a separate entity within the hospital IT environment. Surveys of ICU's working with a CIS, revealed that

Conflict of interest

R.J. Bosman is a consultant for iMDsoft, Massachusetts, USA.

References (92)

  • A. Alapetite

    Impact of noise and other factors on speech recognition in anaesthesia

    International Journal of Medical Informatics

    (2008)

  • The 2004 Gartner Computer-Based Patient Record System Generation Model

  • M.K. Robnett

    Critical care nursing: workforce issues and potential solutions

    Critical Care Medicine

    (2006)
  • A. Grover

    Critical care workforce: a policy perspective

    Critical Care Medicine

    (2006)
  • D.C. Angus et al.

    Caring for the critically ill patient. Current and projected workforce requirements for care of the critically ill and patients with pulmonary disease: can we meet the requirements of an aging population?

    JAMA

    (2000)
  • D.F. Sittig

    Work-sampling: a statistical approach to evaluation of the effect of computers on work patterns in healthcare

    Methods of Information in Medicine

    (1993)
  • G. Borg

    The Borg RPE Scale

  • T.A. Massaro

    Introducing physician order entry at a major academic medical center: II. Impact on medical education

    Academic Medicine

    (1993)
  • M. Apkon et al.

    Impact of an electronic information system on physician workflow and data collection in the intensive care unit

    Intensive Care Medicine

    (2001)
  • R.J. Bosman et al.

    Intensive care information system reduces documentation time of the nurses after cardiothoracic surgery

    Intensive Care Medicine

    (2003)
  • K.E. Bradshaw et al.

    Computer-based data entry for nurses in the ICU

    M.D. Computing

    (1989)
  • A. Donati et al.

    The impact of a clinical information system in an intensive care unit

    Journal of Clinical Monitoring and Computing

    (2008)
  • L.M. Korst et al.

    Nursing documentation time during implementation of an electronic medical record

    The Journal of Nursing Administration

    (2003)
  • C. Marasovic et al.

    A comparison of nursing activities associated with manual and automated documentation in an Australian intensive care unit

    Computers in Nursing

    (1997)
  • J.A. Menke et al.

    Computerized clinical documentation system in the pediatric intensive care unit

    BMC Medical Informatics and Decision Making

    (2001)
  • S. Minda et al.

    Time differences in handwritten and computer documentation of nursing assessment

    Computers in Nursing

    (1994)
  • G.L. Pierpont et al.

    Effect of computerized charting on nursing activity in intensive care

    Critical Care Medicine

    (1995)
  • K. Saarinen et al.

    Does the implementation of a clinical information system decrease the time intensive care nurses spend on documentation of care?

    Acta Anaesthesiologica Scandinavica

    (2005)
  • M.B. Weinger et al.

    The effect of electronic record keeping and transesophageal echocardiography on task distribution, workload, and vigilance during cardiac anesthesia

    Anesthesiology

    (1997)
  • C. White et al.

    Automating the bedside

    Healthcare Informatics

    (1997)
  • D.H. Wong et al.

    Changes in intensive care unit nurse task activity after installation of a third-generation intensive care unit information system

    Critical Care Medicine

    (2003)
  • D.J. Fraenkel et al.

    Quality benefits of an intensive care clinical information system

    Critical Care Medicine

    (2003)
  • L.H. Aiken et al.

    Educational levels of hospital nurses and surgical patient mortality

    JAMA

    (2003)
  • W.G. Cole

    Integrality and meaning: essential and orthogonal dimensions of graphical data display

    Proceedings Annual Symposium on Computer Applications in Medical Care

    (1993)
  • M.F. Lesser

    GIFIC. A graphical interface for intensive care

    Proceedings Annual Symposium on Computer Applications in Medical Care

    (1994)
  • L.A. Eidelman et al.

    The philosophy of monitoring

    Current Opinion of Critical Care

    (1996)
  • A. Csomos et al.

    Comparative costing analysis of intensive care services between Hungary and United Kingdom

    Intensive Care Medicine

    (2005)
  • A. Macario et al.

    Where are the costs in perioperative care? Analysis of hospital costs and charges for inpatient surgical care

    Anesthesiology

    (1995)
  • D. Negrini et al.

    International Programme for Resource Use in Critical Care (IPOC)–a methodology and initial results of cost and provision in four European countries

    Acta Anaesthesiologica Scandinavica

    (2006)
  • F. Dexter et al.

    Statistical method using operating room information system data to determine anesthetist weekend call requirements

    AANA Journal

    (2000)
  • F. Dexter et al.

    Scheduling surgical cases into overflow block time- computer simulation of the effects of scheduling strategies on operating room labor costs

    Anesthesia and Analgesia

    (2000)
  • F. Dexter et al.

    Use of operating room information system data to predict the impact of reducing turnover times on staffing costs

    Anesthesia and Analgesia

    (2003)
  • D.J. Cullen et al.

    Therapeutic intervention scoring system: a method for quantitative comparison of patient care

    Critical Care Medicine

    (1974)
  • W.A. Knaus et al.

    APACHE II: a severity of disease classification system

    Critical Care Medicine

    (1985)
  • J.L. Vincent et al.

    The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine

    Intensive Care Medicine

    (1996)
  • J.E. Zimmerman et al.

    Acute Physiology and Chronic Health Evaluation (APACHE) IV: hospital mortality assessment for today's critically ill patients

    Critical Care Medicine

    (2006)

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