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Quality of Care

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Updated ICU information systems substantially free nurses from documentation, giving them more time for direct patient care

Implementation of a third-generation intensive care unit (ICU) information system at one medical center decreased the time spent on documentation by ICU nurses by over 30 percent, or about 1 hour of each 8-hour shift. Nurses, in turn, devoted this time to direct patient care tasks, such as taking vital signs, observing and checking equipment function, administering medications, and changing dressings, according to a study supported in part by the Agency for Healthcare Research and Quality (HS11375 and HS11521).

The Quantitative Sentinel (QS) information system examined in this study had electronic interfaces to the ICU physiologic bedside monitors and to the hospital's laboratory information system and patient tracking system. The researchers had a critical care-certified nurse observe 10 ICU nurses in a 10-bed surgical ICU at a Veterans Affairs hospital for 4 consecutive hours on two separate occasions. She observed the nurses once before and once after installation of the QS system. The nurse calculated ICU nurses' performance on 70 distinct tasks categorized into five areas: direct patient care, indirect patient care, documentation, administrative tasks, and housekeeping.

The percentage of time the ICU nurses spent doing documentation decreased from 35.1 to 24.2 percent after the ICU information system was installed. The percentage of time the ICU nurses spent doing direct patient care increased from 31.3 to 40.1 percent. This was particularly notable for patient assessment, which doubled to more than 9 percent of total time and accounted for almost half of the time saved on documentation after the ICU information system was installed.

See "Changes in intensive care unit nurse task activity after installation of a third-generation intensive care unit information system," by David H. Wong, Pharm.D., M.D., Yvonne Gallegos, R.N., M.S.N., Matthew B. Weinger, M.D., and others, in Critical Care Medicine 31(10), pp. 2488-2494, 2003.

Editor's Note: Another AHRQ-supported study on a related topic reveals that most primary care physicians believe that clinical decision support systems could improve their ability to track abnormal test results. For more details, see Murff, H.J., Gandhi, T.K., Karson, A.K., and others (2003). "Primary care physician attitudes concerning follow-up of abnormal test results and ambulatory decision support systems." (AHRQ grant HS11046). International Journal of Medical Informatics 71, pp. 137-149.

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