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电子健康记录利用和临床医生工作流程的时间-动作研究表明,经常需要任务切换和文档负担。

Time-motion examination of electronic health record utilization and clinician workflows indicate frequent task switching and documentation burden.

机构信息

Columbia University Department of Biomedical Informatics, NY, NY.

Columbia University School of Nursing, NY, NY.

出版信息

AMIA Annu Symp Proc. 2021 Jan 25;2020:886-895. eCollection 2020.

Abstract

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.

摘要

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。

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