Dataset Information

A ward-based time study of paper and electronic documentation for recording vital sign observations.

ABSTRACT:

Objective

To investigate time differences in recording observations and an early warning score using traditional paper charts and a novel e-Obs system in clinical practice.

Methods

Researchers observed the process of recording observations and early warning scores across 3 wards in 2 university teaching hospitals immediately before and after introduction of the e-Obs system. The process of recording observations included both measurement and documentation of vital signs. Interruptions were timed and subtracted from the measured process duration. Multilevel modeling was used to compensate for potential confounding factors.

Results

In all, 577 nurse events were observed (281 paper, 296 e-Obs). The geometric mean time to take a complete set of vital signs was 215 s (95% confidence interval [CI], 177 s-262 s) on paper, and 150 s (95% CI, 130 s-172 s) electronically. The treatment effect ratio was 0.70 (95% CI, 0.57-0.85, P < .001). The treatment effect ratio in ward 1 was 0.37 (95% CI, 0.26-0.53), in ward 2 was 0.98 (95% CI, 0.70-1.38), and in ward 3 was 0.93 (95% CI, 0.66-1.33).

Discussion

Introduction of an e-Obs system was associated with a statistically significant reduction in overall time to measure and document vital signs electronically compared to paper documentation. The reductions in time varied among wards and were of clinical significance on only 1 of 3 wards studied.

Conclusion

Our results suggest that introduction of an e-Obs system could lower nursing workload as well as increase documentation quality.

SUBMITTER: Wong D

PROVIDER: S-EPMC7651906 | biostudies-literature | 2017 Jul

REPOSITORIES: biostudies-literature

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Publications

A ward-based time study of paper and electronic documentation for recording vital sign observations.

Wong David D Bonnici Timothy T Knight Julia J Gerry Stephen S Turton James J Watkinson Peter P

Journal of the American Medical Informatics Association : JAMIA 20170701 4

<h4>Objective</h4>To investigate time differences in recording observations and an early warning score using traditional paper charts and a novel e-Obs system in clinical practice.<h4>Methods</h4>Researchers observed the process of recording observations and early warning scores across 3 wards in 2 university teaching hospitals immediately before and after introduction of the e-Obs system. The process of recording observations included both measurement and documentation of vital signs. Interrupt ...[more]

PMID: 28339626

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Project description:BackgroundDocumentation burden is a common problem with modern electronic health record (EHR) systems. To reduce this burden, various recording methods (eg, voice recorders or motion sensors) have been proposed. However, these solutions are in an early prototype phase and are unlikely to transition into practice in the near future. A more pragmatic alternative is to directly modify the implementation of the existing functionalities of an EHR system.ObjectiveThis study aims to assess the nature of free-text comments entered into EHR flowsheets that supplement quantitative vital sign values and examine opportunities to simplify functionality and reduce documentation burden.MethodsWe evaluated 209,055 vital sign comments in flowsheets that were generated in the Epic EHR system at the Vanderbilt University Medical Center in 2018. We applied topic modeling, as well as the natural language processing Clinical Language Annotation, Modeling, and Processing software system, to extract generally discussed topics and detailed medical terms (expressed as probability distribution) to investigate the stories communicated in these comments.ResultsOur analysis showed that 63.33% (6053/9557) of the users who entered vital signs made at least one free-text comment in vital sign flowsheet entries. The user roles that were most likely to compose comments were registered nurse, technician, and licensed nurse. The most frequently identified topics were the notification of a result to health care providers (0.347), the context of a measurement (0.307), and an inability to obtain a vital sign (0.224). There were 4187 unique medical terms that were extracted from 46,029 (0.220) comments, including many symptom-related terms such as "pain," "upset," "dizziness," "coughing," "anxiety," "distress," and "fever" and drug-related terms such as "tylenol," "anesthesia," "cannula," "oxygen," "motrin," "rituxan," and "labetalol."ConclusionsConsidering that flowsheet comments are generally not displayed or automatically pulled into any clinical notes, our findings suggest that the flowsheet comment functionality can be simplified (eg, via structured response fields instead of a text input dialog) to reduce health care provider effort. Moreover, rich and clinically important medical terms such as medications and symptoms should be explicitly recorded in clinical notes for better visibility.

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Dataset Information

A ward-based time study of paper and electronic documentation for recording vital sign observations.

Objective

Methods

Results

Discussion

Conclusion

Publications

A ward-based time study of paper and electronic documentation for recording vital sign observations.

Similar Datasets

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