Department of Critical Care, CHU Sainte-Justine, Montreal, QC, Canada.
Project Management Office, CHU Sainte-Justine, Montreal, QC, Canada.
Pediatr Crit Care Med. 2018 Apr;19(4):e172-e179. doi: 10.1097/PCC.0000000000001450.
To assess caregivers' patient care time before and after the implementation of a reorganization of care plan with electronic medical records.
A prospective, observational, time-motion study.
A level 3 PICU.
Nurses and orderlies caring for intubated patients during an 8-hour work shift before (2008-2009) and after (2016) implementation of reorganization of care in 2013.
The reorganization plan included improved telecommunication for healthcare workers, increased tasks delegated to orderlies, and an ICU-specific electronic medical record (Intellispace Critical Care and Anesthesia information system, Philips Healthcare).
Time spent completing various work tasks was recorded by direct observation, and proportion of time in tasks was compared for each study period. A total of 153.7 hours was observed from 22 nurses and 14 orderlies. There was no significant difference in the proportion of nursing patient care time before (68.8% [interquartile range, 48-72%]) and after (55% [interquartile range, 51-57%]) (p = 0.11) the reorganization with electronic medical record. Direct patient care task time for nurses was increased from 27.0% (interquartile range, 30-37%) before to 34.7% (interquartile range, 33-75%) (p = 0.336) after, and indirect patient care tasks decreased from 33.6% (interquartile range, 23-41%) to 18.6% (interquartile range, 16-22%) (p = 0.036). Documentation time significantly increased from 14.5% (interquartile range, 12-22%) to 26.2% (interquartile range, 23-28%) (p = 0.032). Nursing productivity ratio improved from 28.3 to 26.0. A survey revealed that nursing staff was satisfied with the electronic medical record, although there was a concern for the maintenance of oral communication in the unit.
The reorganization of care with the implementation of an ICU-specific electronic medical record in the PICU did not change total patient care provided but improved nursing productivity, resulting in improved efficiency. Documentation time was significantly increased, and concern over reduced oral communication arose, which should be a focus for future electronic improvement strategies.
评估在实施电子病历护理计划重组前后护理人员的患者护理时间。
前瞻性、观察性、时间运动研究。
3 级 PICU。
在 2013 年实施护理计划重组前后（2008-2009 年和 2016 年），在 8 小时轮班期间照顾插管患者的护士和勤杂工。
重组计划包括改善医疗保健工作者的远程通信、增加分配给勤杂工的任务以及 ICU 特定的电子病历（Intellispace 重症监护和麻醉信息系统，飞利浦医疗保健）。
通过直接观察记录完成各种工作任务所花费的时间，并比较每个研究期间任务时间的比例。从 22 名护士和 14 名勤杂工中观察到 153.7 小时。在实施电子病历前后（55%[四分位距，51%-57%]和 68.8%[四分位距，48%-72%]），护理患者的时间比例没有显著差异（p=0.11）。护士直接护理患者的时间从重组前的 27.0%（四分位距，30%-37%）增加到重组后的 34.7%（四分位距，33%-75%）（p=0.336），间接护理患者的时间从 33.6%（四分位距，23%-41%）减少到 18.6%（四分位距，16%-22%）（p=0.036）。文件记录时间从 14.5%（四分位距，12%-22%）显著增加到 26.2%（四分位距，23%-28%）（p=0.032）。护理生产力比率从 28.3 提高到 26.0。一项调查显示，护理人员对电子病历感到满意，尽管有人担心单位内口头沟通的维护。
在 PICU 实施 ICU 特定的电子病历护理计划重组并没有改变提供的总患者护理，但提高了护理生产力，从而提高了效率。文件记录时间显著增加，并且对口头沟通减少的担忧出现，这应该是未来电子改进策略的重点。
