Department of Veterans Affairs, Pain Research Informatics Multimorbidities and Education Center, VA-CT, West Haven, Connecticut, United States.
Department of Biomedical Informatics and Data Science, Yale University School of Medicine, New Haven, Connecticut, United States.
Appl Clin Inform. 2024 Oct;15(5):898-913. doi: 10.1055/a-2385-1654. Epub 2024 Aug 13.
Efforts to reduce documentation burden (DocBurden) for all health professionals (HP) are aligned with national initiatives to improve clinician wellness and patient safety. Yet DocBurden has not been precisely defined, limiting national conversations and rigorous, reproducible, and meaningful measures. Increasing attention to DocBurden motivated this work to establish a standard definition of DocBurden, with the emergence of excessive DocBurden as a term.
We conducted a scoping review of DocBurden definitions and descriptions, searching six databases for scholarly, peer-reviewed, and gray literature sources, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extensions for Scoping Review guidance. For the concept clarification phase of work, we used the American Nursing Informatics Association's Six Domains of Burden Framework.
A total of 153 articles were included based on a priori criteria. Most articles described a focus on DocBurden, but only 18% ( = 28) provided a definition. We define DocBurden as the stress and unnecessarily heavy work an HP or health care team experiences when usability of documentation systems and documentation activities (i.e., generation, review, analysis, and synthesis of patient data) are not aligned in support of care delivery. A negative connotation was attached to burden without a neutral state in included sources, which does not align with dictionary definitions of burden.
Existing literature does not distinguish between a baseline or required task load to conduct patient care resulting from usability issues (), and the unnecessarily heavy tasks and requirements that contribute to . Our definition of excessive DocBurden explicitly acknowledges this distinction, to support development of meaningful measures for understanding and intervening on excessive DocBurden locally, nationally, and internationally.
减少所有医疗保健专业人员（HP）的文档负担（DocBurden）的努力与改善临床医生健康和患者安全的国家计划相一致。然而，DocBurden 尚未被精确定义，限制了国家对话和严格、可重复和有意义的措施。对 DocBurden 的关注度不断提高，促使我们努力建立 DocBurden 的标准定义，并出现了“过多的 DocBurden”这一术语。
我们对 DocBurden 的定义和描述进行了范围综述，使用 Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extensions for Scoping Review 指南，在六个数据库中搜索学术性、同行评审和灰色文献来源。在这项工作的概念澄清阶段，我们使用了美国护理信息学协会的六个负担领域框架。
根据预先设定的标准，共有 153 篇文章被纳入。大多数文章都关注 DocBurden，但只有 18%（即 28 篇）提供了定义。我们将 DocBurden 定义为 HP 或医疗保健团队在文档系统和文档活动（即生成、审查、分析和综合患者数据）的可用性不支持护理提供时所经历的压力和不必要的繁重工作。在纳入的来源中，负担被赋予了负面含义，而没有中立状态，这与字典中对负担的定义不一致。
现有文献没有区分由于可用性问题导致的进行患者护理的基线或必需任务负载（），以及导致过多负担的不必要的繁重任务和要求（）。我们对过多 DocBurden 的定义明确承认了这一区别，以支持在本地、国家和国际层面开发有意义的措施来理解和干预过多的 DocBurden。
