Weigl Matthias, Hoffmann Florian, Müller Andreas, Barth Nina, Angerer Peter
Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, Munich University, Munich, Germany,
Eur J Pediatr. 2014 May;173(5):637-45. doi: 10.1007/s00431-013-2232-z. Epub 2013 Dec 10.
Frequent workflow interruptions jeopardise clinicians' efficiency and quality of clinical care. We sought to determine the effect of a documentation-assistant intervention. Our hypothesis was that the expected decrease of workflow interruptions enhances paediatricians' performance and simultaneously improves patients' perceived quality of care.
This was a controlled intervention study with data collected before and after the intervention at a University Children's Hospital. For the intervention, a documentation assistant was assigned to an inpatient ward. The main outcome measures were workflow interruptions, paediatricians' performance, as well as patients' perceived quality of care. Workflow interruptions were assessed via standardised expert observations. Paediatricians' evaluated their performance in terms of productivity, quality, and efficiency. Additionally, standardised patients' reports on perceived quality of care were collected.
For paediatricians in the intervention ward, workflow interruptions decreased significantly from 5.2 to 3.1 disruption events per working hour (decrease in the control unit was from 3.8 to 3.1). Furthermore, paediatricians reported at follow-up significantly enhanced productivity, quality, and efficiency. Similarly, patients' ratings of care quality improved significantly over time. In multivariate analyses, we found substantial changes attributable to the intervention: for all three outcomes, we found a significant interaction effect of the intervention over study time.
The intervention streamlined paediatricians' workflow, improved day-to-day functioning of the ward, and enhanced organisational efficiency and delivery of paediatric care. Future studies should investigate potential influences between the reduction of workflow interruptions, paediatricians' perceived performance, and patient-related outcomes in quality and efficiency of paediatric care.
频繁的工作流程中断会危及临床医生的工作效率和临床护理质量。我们试图确定文档辅助干预的效果。我们的假设是，工作流程中断的预期减少会提高儿科医生的表现，同时改善患者对护理质量的感知。
这是一项对照干预研究，在一家大学儿童医院干预前后收集数据。对于干预措施，为一个住院病房分配了一名文档助理。主要结局指标包括工作流程中断情况、儿科医生的表现以及患者对护理质量的感知。通过标准化的专家观察来评估工作流程中断情况。儿科医生从生产力、质量和效率方面评估他们的表现。此外，还收集了标准化患者关于护理质量感知的报告。
对于干预病房的儿科医生，工作流程中断显著减少，从每工作小时5.2次中断事件降至3.1次（对照病房从3.8次降至3.1次）。此外，儿科医生在随访时报告生产力、质量和效率显著提高。同样，患者对护理质量的评分随时间显著改善。在多变量分析中，我们发现干预导致了显著变化：对于所有三个结局，我们发现干预在研究期间有显著的交互作用。
该干预简化了儿科医生的工作流程，改善了病房的日常运作，提高了组织效率和儿科护理服务。未来的研究应调查工作流程中断减少、儿科医生感知的表现以及儿科护理质量和效率方面与患者相关的结局之间的潜在影响。
