Reorganizing ICU care with electronic medical records implementation: A time-motion study of nursing care in the PICU
CCCF ePoster library. Roumeliotis N. 11/01/16; 150925; 46
Dr. Nadia Roumeliotis
Dr. Nadia Roumeliotis
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Topic: Quality Assurance & Improvement

Reorganizing ICU care with electronic medical records implementation: A time–motion study of nursing care in the PICU

Roumeliotis, Nadia1; Parisien, Genevieve2; Charette, Sylvie2; Vallée, Dominique3; Arpin, Elizabeth3; Brunet, Fabrice4; Jouvet, Philippe1
1Critical care unit, CHU Sainte-Justine, Montreal, Canada, 2 Nursing Projet Manager, CHU Sainte-Justine, Montreal, Canada, 3 Nursing director, CHU Sainte-Justine, 4Director General, CHU Sainte-Justine, Montreal, Canada



Introduction: Intensive care units are currently facing challenges of increasing patient complexity and volume, as well as staffing shortages, threatening high quality care. Focus is shifting toward strategies to improve efficiency, accessibility and quality of care in critical care.
Objectives: Assess nursing time spent in direct and indirect care before and after the implementation of a reorganisation of care plan.
Methods: A prospective, observational, time motion study was conducted in a level 3 PICU. Participants were followed during an 8-hour work shift before (2010) and after (2016) implementation of reorganization of care with EMR in 2013. The reorganisation plan included improved telecommunication for health care workers, increased tasks delegated to orderlies, and an Electronic Medical Record (EMR: Intellispace Critical Care and Anaesthesia information system (ICCA), Phillips Medical) in a pediatric intensive care unit (PICU). Time spent completing various work tasks was recorded by direct observation, and compared for each study period. A survey assessing comfort with the EMR was also completed 6 months after implementation.
Results: Eleven nurses were evaluated before and after reorganization of care with EMR. Time spent on various daily tasks was compared in proportion to the amount of time observed. The proportion of time spent on direct patient care tasks was increased from 33% (SD±6) to 53% (SD±6) (p<0.001) after the implementation of EMR. Time spent on indirect patient care tasks decreased from 36% (SD±7) to 29% (SD±5) (p=0.02) along with decreased documentation time from 20 % (SD±6) to 4% (SD±2) (p<0.001). Forty-two nurses completed a survey 6 month post implementation and 81% were either very comfortable or completely confortable with the EMR, however 29% felt that oral communication between members in the unit was not maintained.
Conclusion: The reorganisation of care with the implementation of EMR in the PICU significantly increased the proportion of nursing time spent in direct patient care, and reduced the proportion of time in indirect patient care and documentation tasks. The EMR therefore improved both the efficiency and quality of nursing clinical care in the PICU.


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