Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, Pennsylvania, United States.
Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, United States.
Appl Clin Inform. 2020 Mar;11(2):226-234. doi: 10.1055/s-0040-1705108. Epub 2020 Mar 25.
Physicians may spend a significant amount of time using the electronic health record (EHR), but this is understudied in the pediatric intensive care unit (PICU). The objective of this study is to quantify PICU attending physician EHR usage and determine its association with patient census and mortality scores.
During the year 2016, total EHR, chart review, and documentation times of 7 PICU physicians were collected retrospectively utilizing an EHR-embedded time tracking software package. We examined associations between documentation times and patient census and maximum admission mortality scores. Odds ratios (ORs) are reported per 1-unit increase in patient census and mortality scores.
Overall, total daily EHR usage time (median time [hh:mm] [25th, 75th percentile]) was 2:10 (1:31, 3:08). For all hours (8 a.m.-8 a.m.), no strong association was noted between total EHR time, chart review, and documentation times and patient census, Pediatric Index of Mortality 2 (PIM2), or Pediatric Risk of Mortality 3 (PRISM3) scores. For regular hours (8 a.m.-7 p.m.), no strong association was noted between total EHR, chart review, and documentation times and patient census, PIM2, or PRISM3 scores. When patient census was higher, the odds of EHR after-hour usage (7 p.m.-8 a.m.) was higher (OR 1.262 [1.135, 1.403], < 0.0001), but there were no increased odds with PIM2 (OR 1.090 [0.956, 1.242], = 0.20) and PRISM3 (OR 1.010 [0.984, 1.036], = 0.47) scores. A subset of physicians spent less time performing EHR-related tasks when patient census and admission mortality scores were elevated.
We performed a novel evaluation of physician EHR workflow in our PICU. Our pediatric critical care physicians spend approximately 2 hours (out of an expected 10-hour shift) each service day using the EHR, but there was no strong or consistent association between EHR usage and patient census or mortality scores. Future larger scale studies are needed to ensure validity of these results.
医生可能会花费大量时间使用电子健康记录（EHR），但这在儿科重症监护病房（PICU）中研究较少。本研究的目的是量化 PICU 主治医生使用 EHR 的情况，并确定其与患者人数和死亡率评分的关系。
在 2016 年期间，利用 EHR 嵌入式时间跟踪软件包回顾性地收集了 7 名 PICU 医生的总 EHR、病历回顾和记录时间。我们检查了记录时间与患者人数和入院死亡率评分之间的关系。每增加一个单位的患者人数和死亡率评分，比值比（OR）都会有所报告。
总的来说，每天的总 EHR 使用时间（中位数时间[小时：分钟] [25 分位数，75 分位数]）为 2:10（1:31，3:08）。在所有时间（上午 8 点至上午 8 点），EHR 总时间、病历回顾和记录时间与患者人数、儿童死亡率 2 评分（PIM2）或儿科死亡率 3 评分（PRISM3）之间没有很强的关联。在正常工作时间（上午 8 点至下午 7 点），EHR 总时间、病历回顾和记录时间与患者人数、PIM2 或 PRISM3 评分之间没有很强的关联。当患者人数较高时，EHR 夜间使用（下午 7 点至上午 8 点）的几率更高（OR 1.262[1.135，1.403]，<0.0001），但 PIM2（OR 1.090[0.956，1.242]，=0.20）和 PRISM3（OR 1.010[0.984，1.036]，=0.47）评分没有增加的几率。当患者人数和入院死亡率评分较高时，一部分医生花在与 EHR 相关任务上的时间减少了。
我们对 PICU 中医生的 EHR 工作流程进行了新颖的评估。我们的儿科重症监护医生每天在服务中大约花费 2 个小时（在 10 小时轮班中）使用 EHR，但 EHR 使用与患者人数或死亡率评分之间没有很强或一致的关联。需要进行更大规模的未来研究以确保这些结果的有效性。
