Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, MA, United States of America.
Brigham and Women's Hospital, Boston, MA, United States of America.
PLoS One. 2019 Feb 25;14(2):e0212816. doi: 10.1371/journal.pone.0212816. eCollection 2019.
The majority of U.S hospitals have implemented electronic health records (EHRs). While the benefits of EHRs have been widely touted, little is known about their effects on inpatient care, including how well they meet workflow needs and support care.
Assess the extent to which EHRs support care team workflow during hospital morning rounds.
We applied a mixed-method approach including observations of care teams during morning rounds, semi-structured interviews and an electronic survey of hospital inpatient clinicians. Structured field notes taken during observations were used to identify workflow patterns for analysis. We applied a grounded theory approach to extract emerging themes from interview transcripts and used SPSS Statistics 24 to analyze survey responses.
Medical units at a major teaching hospital in New England.
Data triangulation across the three analyses yielded four main findings: (1) a high degree of variance in the ways care teams use EHRs during morning rounds. (2) Pervasive use of workarounds at critical points of care (3) EHRs are not used for information sharing and frequently impede intra-care team communication. (4) System design and hospital room settings do not adequately support care team workflow.
Gaps between EHR design and the functionality needed in the complex inpatient environment result in lack of standardized workflows, extensive use of workarounds and team communication issues. These issues pose a threat to patient safety and quality of care. Possible solutions need to include improvements in EHR design, care team training and changes to the hospital room setting.
大多数美国医院都已经实施了电子健康记录（EHR）系统。尽管 EHR 系统的好处已经被广泛宣传，但对于其对住院病人护理的影响却知之甚少，包括它们在满足工作流程需求和支持护理方面的效果如何。
评估 EHR 系统在医院查房期间在多大程度上支持护理团队的工作流程。
我们采用了一种混合方法，包括在查房期间观察护理团队、半结构化访谈以及对医院住院临床医生的电子调查。在观察过程中记录的结构化现场笔记用于识别用于分析的工作流程模式。我们采用扎根理论方法从访谈记录中提取出现的主题，并使用 SPSS Statistics 24 分析调查回复。
新英格兰一家主要教学医院的医疗病房。
通过对这三个分析的三角验证，得出了四个主要发现：（1）护理团队在查房期间使用 EHR 系统的方式存在很大差异。（2）在护理关键节点普遍存在工作流程的替代方案。（3）EHR 系统未用于信息共享，并且经常阻碍团队内部沟通。（4）系统设计和医院病房设置不能充分支持护理团队的工作流程。
EHR 设计与复杂住院环境中所需功能之间的差距导致工作流程缺乏标准化、大量使用替代方案以及团队沟通问题。这些问题对患者安全和护理质量构成威胁。可能的解决方案需要包括改进 EHR 设计、护理团队培训和改变医院病房设置。
