School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK.
Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
J Am Med Inform Assoc. 2020 May 1;27(5):798-807. doi: 10.1093/jamia/ocz231.
Nursing time represents one of the highest costs for most health services. We conducted a systematic review of the literature on the impact of health information technology on nurses' time.
We followed PRISMA guidelines and searched 6 large databases for relevant articles published between Jan 2004 and December 2019. Two authors reviewed the titles, abstracts, and full texts. We included articles that included a comparison group in the design, measured the time taken to carry out documentation or medication administration, documented the quantitative estimates of time differences between the 2, had nurses as subjects, and was conducted in either a care home, hospital, or community clinic.
We identified a total of 1647 articles, of which 33 met our inclusion criteria. Twenty-one studies reported the impact of 12 different health information technology (HIT) implementations on nurses' documentation time. Weighted averages were calculated for studies that implemented barcode medication administration (BCMA) and 2 weighted averages for those that implemented EHRs, as these studies used different sampling units; both showed an increase in the time spent in documentation (+22% and +46%). However, the time spent carrying out medication administration following BCMA implementation fell by 33% (P < .05). HIT also caused a redistribution of nurses' time which, in some cases, was spent in more "value-adding" activities, such as delivering direct patient care as well as inter-professional communication.
Most of the HIT systems increased nursing documentation time, although time fell for medication administration following BCMA. Many HIT systems also resulted in nurses spending more time in direct care and "value-adding" activities.
护理时间是大多数医疗服务中成本最高的一项。我们对健康信息技术对护士时间的影响进行了系统评价。
我们遵循 PRISMA 指南，在 6 个大型数据库中搜索了 2004 年 1 月至 2019 年 12 月期间发表的相关文章。两位作者对标题、摘要和全文进行了审查。我们纳入了设计中包含对照组、测量记录或给药时间、记录 2 个时间差异的定量估计值、以护士为研究对象、在养老院、医院或社区诊所进行的文章。
我们共发现了 1647 篇文章，其中 33 篇符合我们的纳入标准。21 项研究报告了 12 种不同健康信息技术（HIT）实施对护士记录时间的影响。对实施条码给药管理（BCMA）和 2 项实施电子病历（EHR）的研究进行了加权平均，因为这些研究使用了不同的抽样单位；两者都显示记录时间增加（分别增加 22%和 46%）。然而，BCMA 实施后给药时间减少了 33%（P < 0.05）。HIT 还导致护士时间的重新分配，在某些情况下，护士会花费更多的时间进行更有“附加值”的活动，如直接提供患者护理以及跨专业沟通。
大多数 HIT 系统增加了护理记录时间，尽管 BCMA 实施后给药时间减少了。许多 HIT 系统还导致护士在直接护理和“附加值”活动上花费更多时间。
