Reorganizing Care With the Implementation of Electronic Medical Records: A Time-Motion Study in the PICU

Objectives: To assess caregivers’ patient care time before and after the implementation of a reorganization of care plan with electronic medical records. Design: A prospective, observational, time-motion study. Setting: A level 3 PICU. Participants: Nurses and orderlies caring for intubated patients during an 8-hour work shift before (2008–2009) and after (2016) implementation of reorganization of care in 2013. Interventions: The reorganization plan included improved telecommunication for healthcare workers, increased tasks delegated to orderlies, and an ICU-specific electronic medical record (Intellispace Critical Care and Anesthesia information system, Philips Healthcare). Measurements and Main Results: Time spent completing various work tasks was recorded by direct observation, and proportion of time in tasks was compared for each study period. A total of 153.7 hours was observed from 22 nurses and 14 orderlies. There was no significant difference in the proportion of nursing patient care time before (68.8% [interquartile range, 48–72%]) and after (55% [interquartile range, 51–57%]) (p = 0.11) the reorganization with electronic medical record. Direct patient care task time for nurses was increased from 27.0% (interquartile range, 30–37%) before to 34.7% (interquartile range, 33–75%) (p = 0.336) after, and indirect patient care tasks decreased from 33.6% (interquartile range, 23–41%) to 18.6% (interquartile range, 16–22%) (p = 0.036). Documentation time significantly increased from 14.5% (interquartile range, 12–22%) to 26.2% (interquartile range, 23–28%) (p = 0.032). Nursing productivity ratio improved from 28.3 to 26.0. A survey revealed that nursing staff was satisfied with the electronic medical record, although there was a concern for the maintenance of oral communication in the unit. Conclusions: The reorganization of care with the implementation of an ICU-specific electronic medical record in the PICU did not change total patient care provided but improved nursing productivity, resulting in improved efficiency. Documentation time was significantly increased, and concern over reduced oral communication arose, which should be a focus for future electronic improvement strategies. Drs. Roumeliotis’ and Jouvet’s institutions received funding from Fonds de Recherche Quebec–Santé (public research agency of Quebec). Dr. Jouvet received funding from the Quebec Ministry of Health and Ste-Justine Hospital. Dr. Jouvet has been invited to conferences by Covidien, Medunik Inc, and AirLiquid Santé. Medical devices are lent to Dr. Jouvet by Hamilton Medical, Philips Medical, Maquet. Dr. Parisien received support for article research from Sainte-Justine hospital funding, and she disclosed government work. Ms. Charette disclosed government work. The remaining authors have disclosed that they do not have any conflicts of interest. For information regarding this article, E-mail: Philippe.jouvet@umontreal.ca ©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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