Tang Zhihua, Weavind Liza, Mazabob Janine, Thomas Eric J, Chu-Weininger Ming Ying L, Johnson Todd R
School of Health Information Sciences, University of Texas Health Science Center at Houston, USA.
Crit Care Med. 2007 Sep;35(9):2057-63. doi: 10.1097/01.ccm.0000281516.84767.96.
To investigate workflow in intensive care unit remote monitoring, a technology-driven practice that allows critical care specialists to perform proactive and continuous patient care from a remote site.
A time-and-motion study.
Facility that remotely monitored 132 beds in nine intensive care units.
Six physicians and seven registered nurses.
Participants were observed for 47 and 39 hrs, respectively.
Clinicians' workflow was analyzed as goal-oriented tasks and activities. Major variables of interest included the times spent on different types of tasks and activities, the frequencies of accessing various information resources, and the occurrence and management of interruptions in workflow. Physicians spent 70%, 3%, 3%, and 24% of their time on patient monitoring, collaboration, system maintenance, and administrative/social/personal tasks, respectively. For nurses, the time allocations were 46%, 3%, 4%, and 17%, respectively. Nurses spent another 30% of their time maintaining health records. In monitoring patients, physicians spent more percentage times communicating with others than the nurses (13% vs. 7%, p = .026) and accessed the in-unit clinical information system more frequently (42 vs. 14 times per hour, p = .027), while nurses spent more percentage times monitoring real-time vitals (16% vs. 2%, p = .012). Physicians' and nurses' workflows were interrupted at a rate of 2.2 and 7.5 times per hour (p < .001), with an average duration of 101 and 45 secs, respectively (p = .006). The sources of interruptions were significantly different for physicians and nurses (p < .001).
Physicians' and nurses' task performance and information utilization reflect the distributed nature of work organization in intensive care unit remote monitoring. Workflow interruption, clinical information system usability, and collaboration with bedside caregivers are the major issues that may affect the quality and efficiency of clinicians' work in this particular critical care setting.
调查重症监护病房远程监测的工作流程，这是一种技术驱动的实践，使重症监护专家能够在远程站点进行主动和持续的患者护理。
一项时间与动作研究。
对九个重症监护病房的132张床位进行远程监测的机构。
六位医生和七位注册护士。
分别对参与者进行了47小时和39小时的观察。
将临床医生的工作流程分析为以目标为导向的任务和活动。主要关注变量包括在不同类型任务和活动上花费的时间、访问各种信息资源的频率以及工作流程中断的发生和管理情况。医生分别将70%、3%、3%和24%的时间用于患者监测、协作、系统维护以及行政/社交/个人任务。对于护士而言，时间分配分别为46%、3%、4%和17%。护士还将另外30%的时间用于维护健康记录。在监测患者时，医生用于与他人沟通的时间百分比高于护士（13%对7%，p = 0.026），且更频繁地访问病房内临床信息系统（每小时42次对14次，p = 0.027），而护士用于监测实时生命体征的时间百分比更高（16%对2%，p = 0.012）。医生和护士的工作流程中断频率分别为每小时2.2次和7.5次（p < 0.001），平均持续时间分别为101秒和45秒（p = 0.006）。医生和护士的中断来源存在显著差异（p < 0.001）。
医生和护士的任务执行情况及信息利用情况反映了重症监护病房远程监测中工作组织的分布式性质。工作流程中断、临床信息系统可用性以及与床边护理人员的协作是可能影响临床医生在这种特殊重症监护环境下工作质量和效率的主要问题。
