Time Motion Study in a Pediatric Emergency Department Before and After Computer Physician Order Entry
Time Motion Study in a Pediatric Emergency Department Before and After Computer Physician Order Entry
复制标题
DOI：
10.1016/j.annemergmed.2008.09.018
复制
发表时间：
2009-04-01
影响因子：
6.2
通讯作者：
Gorelick, Marc H.
中科院分区：
文献类型：
--
作者：
Yen, Kenneth;Shane, Elizabeth L.;Gorelick, Marc H.
研究目的：探讨计算机医嘱录入对儿科急诊科（ED）医护人员时间分配的影响。我们试图确定急诊科护理人员在电脑上的时间增加是否会减少与患者相处的时间。方法：这是一项在城市儿科急诊科进行的前后观察时间和运动研究。观察人员记录了在计算机医生指令输入之前的夏季，护理人员如何在180分钟的观察期内以30秒的增量分配他们的时间。计算机上的时间以秒为单位记录下来。观察结果分为3类（直接患者护理、间接患者护理、其他），每一类都有自己的子类。结果：主治医师的计算机时间中位数从输入计算机医嘱前的5.0分钟增加到输入计算机医嘱后的9.5分钟（P= 0.01）。住院医师的计算机时间中位数从输入计算机医嘱前的5.5分钟增加到输入计算机医嘱后的14.3分钟（P=.001）。对于护士来说，在电脑输入医嘱前后，在电脑上的时间没有显著差异（P=.15），尽管在时间分配上似乎仍然有一些变化。计算机输入医嘱后，护士与工作人员谈论病人护理的时间从24.5分钟减少到13.3分钟（P= 0.01）。计算机医嘱输入并没有减少任何护理人员与患者在一起的时间。结论：在儿科急诊科增加计算机医嘱输入增加了主治医生和住院医生在计算机上花费的时间，但对急诊护士没有影响。计算机上的这些额外时间是由非患者护理活动分配的。计算机医嘱输入的增加减少了护士与其他工作人员讨论病人护理的时间。[j] .中华急诊医学杂志。2009;53:46 -468。
Study objective: To determine the effect of computer physician order entry on pediatric emergency department (ED) care providers allocation of time. We seek to determine whether the increase in time by ED care providers on the computer will decrease time spent with patients.Methods: This was a before-and-after observational time-and-motion study conducted at an urban pediatric ED. Observers recorded how caregivers allocated their time during 180-minute observation periods at 30-second increments the summers before after computer physician order entry introduction. Time on the computer was recorded in seconds. Observations were placed into 3 categories (direct patient care, indirect patient care, other), each with its own subcategories.Results: For attending physicians, median computer time increased from 5.0 minutes before computer physician order entry to 9.5 minutes after computer physician order entry (P=.01). For resident physicians, median computer time increased from 5.5 minutes before computer physician order entry to 14.3 minutes after computer physician order entry (P=.001). For nurses, time on the computer was not significantly different before and after computer physician order entry (P=.15), although it appears there was still some change in time allocation. After computer physician order entry, nurses' talking with staff about patient care decreased from 24.5 minutes to 13.3 minutes (P=.01). Computer physician order entry did not decrease time with patients for any of the caregiver types.Conclusion: The addition of computer physician order entry to a pediatric ED increases time spent on the computer by both attending and resident physicians but not for emergency nurses. This additional time on the computer is allocated from nonpatient care activities. The addition of computer physician order entry decreases nurses' time talking with other staff for patient care. [Ann Emerg Med. 2009;53:462-468.]