Columbia University Department of Biomedical Informatics, NY, NY.
Columbia University School of Nursing, NY, NY.
AMIA Annu Symp Proc. 2021 Jan 25;2020:886-895. eCollection 2020.
Clinical documentation burden has been broadly acknowledged, yet few interprofessional measures of burden exist. Using interprofessional time-motion study (TMS) data, we evaluated clinical workflows with a focus on electronic health record (EHR) utilization and fragmentation among 47 clinicians: 34 advanced practice providers (APPs) and 13 registered nurses (RNs) from: an acute care unit (n=15 observations [obs]), intensive care unit (n=14), ambulatory clinic (n=3), and emergency department (n=15). We examined workflow fragmentation, task-switch type, and task involvement. In our study, clinicians on average exhibited 1.4±0.6 switches per minute in their workflow. Eighty-four (19.6%) of the 429 task-switch types presented in the data accounted for 80.1% of all switches. Among those, data viewing- and data entry-related tasks were involved in 48.2% of all switches, indicating documentation burden may play a critical role in workflow disruptions. Therefore, interruption rate evaluated through task switches may serve as a proxy for measuring burden.
临床文档负担已得到广泛认可,但很少有针对负担的跨专业衡量标准。我们使用跨专业时间-动作研究 (TMS) 数据,通过关注电子健康记录 (EHR) 的使用情况和 47 名临床医生之间的工作流程碎片化,对工作流程进行了评估:34 名高级实践提供者 (APP) 和 13 名注册护士 (RN) 分别来自:急症病房 (n=15 次观察 [obs])、重症监护病房 (n=14)、门诊诊所 (n=3) 和急诊室 (n=15)。我们检查了工作流程的碎片化、任务切换类型和任务参与情况。在我们的研究中,临床医生在其工作流程中平均每分钟表现出 1.4±0.6 次切换。在数据中呈现的 429 种任务切换类型中,有 84 种 (19.6%) 占所有切换的 80.1%。其中,数据查看和数据录入相关任务涉及所有切换的 48.2%,表明文档负担可能在工作流程中断中起着关键作用。因此,通过任务切换评估的中断率可以作为衡量负担的替代指标。