Mador Rebecca L, Shaw Nicola T
University of Alberta, Faculty of Medicine & Dentistry, Department of Medicine, Edmonton, AB, Canada.
Int J Med Inform. 2009 Jul;78(7):435-45. doi: 10.1016/j.ijmedinf.2009.01.002. Epub 2009 Mar 3.
The introduction of a Critical Care Information System (CCIS) into an intensive care unit (ICU) is purported to reduce the time health care providers (HCP) spend on documentation and increase the time available for direct patient care. However, there is a paucity of rigorous empirical research that has investigated these assertions. Moreover, those studies that have sought to elucidate the relationship between the introduction of a CCIS and the time spent by staff on in/direct patient care activities have published contradictory findings. The objective of this literature review is to establish the impact of a CCIS on time spent documenting and in direct patient care by staff in the ICU.
Five electronic databases were searched including PubMed Central, EMBASE, CINAHL, IEEE Xplore, and the Cochrane Database of Systematic Reviews. Reference lists of all published papers were hand searched, and citations reviewed to identify extra papers. We included studies that were empirical articles, published in English, and provided original data on the impact of a CCIS on time spent documenting and in direct patient care by staff in the ICU.
In total, 12 articles met the inclusion criteria. Workflow analysis (66%) and time-and-motion analysis (25%) were the most common forms of data collection. Three (25%) studies found an increase in time spent charting, five (42%) found no difference, and four (33%) studies reported a decrease. Results on the impact of a CCIS on direct patient care were similarly inconclusive.
Due to the discrepant findings and several key methodological issues, the impact of a CCIS on time spent charting and in direct patient care remains unclear. This review highlights the need for an increase in rigorous empirical research in this area and provides recommendations for the design and implementation of future studies.
在重症监护病房（ICU）引入重症监护信息系统（CCIS）据称可减少医护人员（HCP）用于文档记录的时间，并增加可用于直接患者护理的时间。然而，缺乏严谨的实证研究来调查这些断言。此外，那些试图阐明引入CCIS与工作人员在直接/间接患者护理活动上花费的时间之间关系的研究得出了相互矛盾的结果。这篇文献综述的目的是确定CCIS对ICU工作人员记录时间和直接患者护理时间的影响。
检索了五个电子数据库，包括PubMed Central、EMBASE、CINAHL、IEEE Xplore和Cochrane系统评价数据库。对所有已发表论文的参考文献列表进行手工检索，并审查引用文献以识别额外的论文。我们纳入了以英文发表的实证文章研究，并提供了关于CCIS对ICU工作人员记录时间和直接患者护理时间影响的原始数据。
总共有12篇文章符合纳入标准。工作流程分析（66%）和时间动作分析（25%）是最常见的数据收集形式。三项（25%）研究发现记录时间增加，五项（42%）研究发现没有差异，四项（33%）研究报告记录时间减少。关于CCIS对直接患者护理影响的结果同样没有定论。
由于结果存在差异以及几个关键的方法学问题,CCIS对记录时间和直接患者护理时间的影响仍不明确。这篇综述强调了在该领域增加严谨实证研究的必要性，并为未来研究的设计和实施提供了建议。
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