France Daniel J, Levin Scott, Hemphill Robin, Chen Kong, Rickard Dorsey, Makowski Renee, Jones Ian, Aronsky Dominik
Vanderbilt University Medical Center, Department of Medicine, S1108 Medical Center North, Nashville, TN 37232-2668, USA.
Int J Med Inform. 2005 Oct;74(10):827-37. doi: 10.1016/j.ijmedinf.2005.03.015.
As the demands on the emergency medicine (EM) system continue to increase, improvements in the organization of work and the access to timely clinical and system information will be required for providers to manage their workload in a safe and efficient manner. Information technology (IT) solutions are beginning to find their place in the emergency department (ED) and it is time to begin understanding how these systems are effecting physician behavior, communication and workload.
The study used a time-in-motion, primary task analyses to study faculty and resident physician behavior in the presence of an electronic whiteboard. The NASA-Task Load Index (TLX) was used to measure subjective workload and the underlying dimensions of workload at the end of each physician observation. Work, communication and workload were characterized using descriptive statistics and compared using Mann-Whitney U-tests.
Physicians in our study performed more tasks and were interrupted less than physicians studied previously in conventional EDs. Interruptions interrupted direct patient care tasks less than other clinical activities. Temporary interruptions appear to be a major source of inefficiency in the ED, and likely a major threat to patient safety. Face-to-face interruptions persist even in the presence of advanced IT systems, such as the electronic whiteboard. Faculty physicians exhibited lower workload scores than resident physicians. Frustration was a significant contributing factor to workload in resident physicians. All physicians ranked temporal demands and mental demands as major contributing factors to workload.
The results indicate that the electronic whiteboard improves the efficiency of work and communication in the ED. IT solutions may have great utility in improving provider situational awareness and distributing workload among ED providers. The results also demonstrate that IT solutions alone will not solve all problems in the ED. IT solutions will probably be most effective in improving efficiency and safety outcomes when paired with human-based interventions, such as crew resource management. Future studies must investigate team interaction, workload and situational awareness, and the association of these factors to patient and provider outcomes.
随着对急诊医学（EM）系统的需求持续增加，为使医护人员能够安全、高效地管理其工作量，需要改进工作组织方式并获取及时的临床和系统信息。信息技术（IT）解决方案已开始在急诊科（ED）中得到应用，现在是时候开始了解这些系统如何影响医生的行为、沟通和工作量了。
本研究采用动态时间、主要任务分析法，研究在电子白板存在的情况下教职医生和住院医生的行为。在每次医生观察结束时，使用美国国家航空航天局任务负荷指数（TLX）来测量主观工作量以及工作量的潜在维度。使用描述性统计对工作、沟通和工作量进行特征描述，并使用曼-惠特尼U检验进行比较。
我们研究中的医生比之前在传统急诊科研究的医生执行的任务更多且被打断的次数更少。中断对直接患者护理任务的干扰少于对其他临床活动的干扰。临时中断似乎是急诊科效率低下的主要原因，也可能是对患者安全的主要威胁。即使在存在电子白板等先进IT系统的情况下，面对面的中断仍然存在。教职医生的工作量得分低于住院医生。挫败感是住院医生工作量的一个重要促成因素。所有医生都将时间需求和心理需求列为工作量的主要促成因素。
结果表明，电子白板提高了急诊科的工作和沟通效率。IT解决方案在提高医护人员的态势感知能力以及在急诊科医护人员之间分配工作量方面可能具有很大的效用。结果还表明，仅靠IT解决方案无法解决急诊科的所有问题。当与基于人的干预措施（如机组资源管理）相结合时，IT解决方案可能在提高效率和安全结果方面最有效。未来的研究必须调查团队互动、工作量和态势感知，以及这些因素与患者和医护人员结果之间的关联。
