Grigg Eliot, Palmer Andrew, Grigg Jeffrey, Oppenheimer Peter, Wu Tim, Roesler Axel, Nair Bala, Ross Brian
Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA.
Department of Sociology, University of Wisconsin, Madison, Wisconsin, USA.
Emerg Med J. 2014 Oct;31(10):833-9. doi: 10.1136/emermed-2013-202512. Epub 2013 Jul 29.
To evaluate the ability of an electronic system created at the University of Washington to accurately document prerecorded VF and pulseless electrical activity (PEA) cardiac arrest scenarios compared with the American Heart Association paper cardiac arrest record.
16 anaesthesiology residents were randomly assigned to view one of two prerecorded, simulated VF and PEA scenarios and asked to document the event with either the paper or electronic system. Each subject then repeated the process with the other video and documentation method. Five types of documentation errors were defined: (1) omission, (2) specification, (3) timing, (4) commission and (5) noise. The mean difference in errors between the paper and electronic methods was analysed using a single factor repeated measures ANOVA model.
Compared with paper records, the electronic system omitted 6.3 fewer events (95% CI -10.1 to -2.5, p=0.003), which represents a 28% reduction in omission errors. Users recorded 2.9 fewer noise items (95% CI -5.3 to -0.6, p=0.003) when compared with paper, representing a 36% decrease in redundant or irrelevant information. The rate of timing (Δ=-3.2, 95% CI -9.3 to 3.0, p=0.286) and commission (Δ=-4.4, 95% CI -9.4 to 0.5, p=0.075) errors were similar between the electronic system and paper, while the rate of specification errors were about a third lower for the electronic system when compared with the paper record (Δ=-3.2, 95% CI -6.3 to -0.2, p=0.037).
Compared with paper documentation, documentation with the electronic system captured 24% more critical information during a simulated medical emergency without loss in data quality.
评估华盛顿大学创建的电子系统与美国心脏协会纸质心脏骤停记录相比，准确记录预先录制的室颤（VF）和无脉电活动（PEA）心脏骤停场景的能力。
16名麻醉科住院医师被随机分配观看两个预先录制的模拟VF和PEA场景之一，并要求使用纸质或电子系统记录该事件。然后，每个受试者用另一个视频和记录方法重复该过程。定义了五种记录错误类型：（1）遗漏，（2）详述，（3）时间记录，（4）添加和（5）噪声。使用单因素重复测量方差分析模型分析纸质和电子方法之间错误的平均差异。
与纸质记录相比，电子系统遗漏的事件少6.3个（95%可信区间-10.1至-2.5，p=0.003），这代表遗漏错误减少了28%。与纸质记录相比，用户记录的噪声项少2.9个（95%可信区间-5.3至-0.6，p=0.003），这代表冗余或无关信息减少了36%。电子系统和纸质记录在时间记录（Δ=-3.2，95%可信区间-9.3至3.0，p=0.286）和添加（Δ=-4.4，95%可信区间-9.4至0.5，p=0.075）错误率方面相似，而与纸质记录相比，电子系统的详述错误率约低三分之一（Δ=-3.2，95%可信区间-6.3至-0.2，p=0.037）。
与纸质记录相比，在模拟医疗紧急情况期间，使用电子系统记录可多获取24%的关键信息，且数据质量无损失。
