The Impact of a Clinical Information System in an Intensive Care Unit

The Effect of Clinical Decision Support Systems on Patients, Nurses, and Work Environment in ICUs: A Systematic Review

This study aimed to examine the impact of clinical decision support systems on patient outcomes, working environment outcomes, and decision-making processes in nursing. The authors conducted a systematic literature review to obtain evidence on studies about clinical decision support systems and the practices of ICU nurses. For this purpose, the authors searched 10 electronic databases, including PubMed, CINAHL, Web of Science, Scopus, Cochrane Library, Ovid MEDLINE, Science Direct, Tr-Dizin, Harman, and DergiPark. Search terms included "clinical decision support systems," "decision making," "intensive care," "nurse/nursing," "patient outcome," and "working environment" to identify relevant studies published during the period from the year 2007 to October 2022. Our search yielded 619 articles, of which 39 met the inclusion criteria. A higher percentage of studies compared with others were descriptive (20%), conducted through a qualitative (18%), and carried out in the United States (41%). According to the results of the narrative analysis, the authors identified three main themes: "patient care outcomes," "work environment outcomes," and the "decision-making process in nursing." Clinical decision support systems, which target practices of ICU nurses and patient care outcomes, have positive effects on outcomes and show promise in improving the quality of care; however, available studies are limited.

Quality of fluid balance charting and interventions to improve it: a systematic review

INTRODUCTION

Fluid balance monitoring is pivotal to patients' health. Thus, fluid balance charting is an essential part of clinical nursing documentation. This systematic review aimed to investigate and describe the quality of fluid balance monitoring in medical, surgical and intensive care units, with an emphasis on the completeness of charting data, calculation errors and accuracy, and to evaluate methods used to improve fluid balance charting.

MATERIALS AND METHODS

Quantitative studies involving adult patients and reporting data on fluid balance monitoring were included in the review. We searched MEDLINE, Embase, CINAHL and the Cochrane Library. The risk of bias in the included studies was assessed using tools developed by the Joanna Briggs Institute.

RESULTS

We included a total of 23 studies, which involved 6649 participants. The studies were quasi-experimental, cohort or prevalence studies, and every third study was of low quality. Definitions of 'completeness' varied, as well as patient categories and time of evaluation. Eighteen studies reported the prevalence of patients with complete fluid balance charts; of those, 10 reported that not more than 50% of fluid balance charts were complete. Studies addressing calculation errors found them in 25%-35% of charts, including omissions of, for example, intravenous medications. The reported interventions consisted of various components such as policies, education, equipment, visual aids, surveillance and dissemination of results. Among studies evaluating interventions, only 38% (5 of 13) achieved compliance with at least 75% of complete fluid balance charts. Due to the heterogeneity of the studies, a meta-analysis was not possible.

CONCLUSION

The quality of fluid balance charting is inadequate in most studies, and calculation errors influence quality. Interventions included several components, and the impact on the completion of fluid balance charts varied.

The Reduction in Medical Errors on Implementing an Intensive Care Information System in a Setting Where a Hospital Electronic Medical Record System is Already in Use: Retrospective Analysis

Background

Although the various advantages of clinical information systems in intensive care units (ICUs), such as intensive care information systems (ICISs), have been reported, their role in preventing medical errors remains unclear.

Objective

This study aimed to investigate the changes in the incidence and type of errors in the ICU before and after ICIS implementation in a setting where a hospital electronic medical record system is already in use.

Methods

An ICIS was introduced to the general ICU of a university hospital. After a step-by-step implementation lasting 3 months, the ICIS was used for all patients starting from April 2019. We performed a retrospective analysis of the errors in the ICU during the 6-month period before and after ICIS implementation by using data from an incident reporting system, and the number, incidence rate, type, and patient outcome level of errors were determined.

Results

From April 2018 to September 2018, 755 patients were admitted to the ICU, and 719 patients were admitted from April 2019 to September 2019. The number of errors was 153 in the 2018 study period and 71 in the 2019 study period. The error incidence rates in 2018 and 2019 were 54.1 (95% CI 45.9-63.4) and 27.3 (95% CI 21.3-34.4) events per 1000 patient-days, respectively (P<.001). During both periods, there were no significant changes in the composition of the types of errors (P=.16), and the most common type of error was medication error.

Conclusions

ICIS implementation was temporally associated with a 50% reduction in the number and incidence rate of errors in the ICU. Although the most common type of error was medication error in both study periods, ICIS implementation significantly reduced the number and incidence rate of medication errors.

Trial Registration

University Hospital Medical Information Network Clinical Trials Registry UMIN000041471; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000047345

[Comparison of current critical care information systems from the perspective of clinical users : Summary of the results of a German nationwide survey]

BACKGROUND

Critical care information systems (CCIS) are computer-based systems designed to process the growing amount of complex medical data in intensive care units (ICU). Previous studies have shown that CCICs can increase the quality of patient care by reducing errors and improving work efficiency; however, other studies have shown that CCISs can also cause harmful effects by disrupting workflow, facilitating medication errors or increasing charting time. The factors that decide whether a CCIS has a positive or negative impact on patient care are summarized under the term "usability". This article summarizes the results of three previously published papers on this topic.

OBJECTIVE

The aim of the study was to identify which CCIS functions were considered useful by clinical ICU staff and how well these functions are implemented in the CCISs currently used in German ICUs.

MATERIAL AND METHODS

An online survey was performed targeting nurses and physicians working in German ICUs using a previously validated questionnaire. The questionnaire included a list of functions (36 for physicians/31 for nurses) that were preselected by experts based on a comprehensive model of ICU work processes. Each of these functions was rated by the study participants on a Likert scale ranging from 0 (worst rating) to 5 (best rating) with respect to the usefulness to identify which functions of CCIS can truly be considered as useful by clinical ICU staff. Furthermore, the participants rated how well these functions were implemented in the CCIS currently in use on the ICU, also using a Likert scale of 0-5. Further questions were provided to rate specific technical usability aspects of the CCISs currently in use. In addition, to capture possible confounders the questionnaire recorded 18 individual and workspace characteristics which might influence the ratings.

RESULTS

A total of 171 nurses and 741 physicians participated in the survey of which 535 used CCISs. Of the functions 33 were rated as useful for doctors and 28 functions for nurses with median scores between 4 and 5. Participants currently using CCISs gave higher ratings compared to participants not using CCISs. The quality of the functions was rated relatively lower than the usefulness and the availability. Furthermore, currently used CCISs in Germany differ greatly in their technical and task-specific usability. Of the CCISs investigated, the system ICUData had the best overall rating and technical usability followed by the systems ICM and MetaVision. The same three CCIS were rated best in task-specific functions without significant differences between them.

CONCLUSION

Those functions that were identified as useful based on the ratings of clinical ICU staff should be implemented in current CCIS. The list of these functions might be regarded as a first step towards providing a catalog of functional requirements for CCISs. Furthermore, as the results show that the quality of the available functions was rated lower than the availability of the functions, manufacturers should shift more of the effort away from the development of new features and focus on improving the user-friendliness and quality of existing functions.

Functional requirements of critical care information systems (CCIS) from the users' perspective

INTRODUCTION

Critical care information systems (CCIS) are computer software systems specialized for supporting the data processing tasks of clinical staff in intensive care units (ICUs). Reports on the impact of CCIS vary strongly from large benefits to harmful impact. One factor causing these inconsistent results is a large functional heterogeneity of the currently available systems, as no standards exist. Therefore, the aim of this study was to derive recommendations for a minimum range of functions that CCIS should incorporate from the perspective of clinical users.

MATERIALS AND METHODS

We performed a web-based survey targeting clinical ICU staff in Germany. Participants rated the usefulness of pre-defined CCIS functions (36 for physicians / 31 for nurses) between 0-5. To capture confounders that might influence the ratings, we recorded 18 individual and workplace characteristics.

RESULTS

The 912 participants rated all but three of the investigated functions as useful with median scores of 4-5. A multivariable analysis showed that the ratings were influenced by whether CCIS were used on the participants' wards, by the rating of the function quality of the used CCIS, the years of work experience and whether the participant was a physician or a nurse.

CONCLUSIONS

Clinical ICU staff considers all but three of the here investigated CCIS functions as useful. Even though we identified a variety of factors influencing the usefulness ratings, their influence is rather small and thus does not limit the validity of our findings. Accordingly, we commend the functions identified as useful to be incorporated in CCIS.

A Prescription for Note Bloat: An Effective Progress Note Template

BACKGROUND

United States hospitals have widely adopted electronic health records (EHRs). Despite the potential for EHRs to increase efficiency, there is concern that documentation quality has suffered.

OBJECTIVE

To examine the impact of an educational session bundled with a progress note template on note quality, length, and timeliness.

DESIGN

A multicenter, nonrandomized prospective trial.

SETTING

Four academic hospitals across the United States.

PARTICIPANTS

Intern physicians on inpatient internal medicine rotations at participating hospitals.

INTERVENTION

A task force delivered a lecture on current issues with documentation and suggested that interns use a newly designed best practice progress note template when writing daily progress notes.

MEASUREMENTS

Note quality was rated using a tool designed by the task force comprising a general impression score, the validated Physician Documentation Quality Instrument, 9-item version (PDQI-9), and a competency questionnaire. Reviewers documented number of lines per note and time signed.

RESULTS

Two hundred preintervention and 199 postintervention notes were collected. Seventy percent of postintervention notes used the template. Significant improvements were seen in the general impression score, all domains of the PDQI-9, and multiple competency items, including documentation of only relevant data, discussion of a discharge plan, and being concise while adequately complete. Notes had approximately 25% fewer lines and were signed on average 1.3 hours earlier in the day.

CONCLUSIONS

The bundled intervention for progress notes significantly improved the quality, decreased the length, and resulted in earlier note completion across 4 academic medical centers.

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.

Nurses’ perceptions about and confidence in using an electronic medical record system

Introduction:

Nurses are among the largest potential users of electronic medical record (EMR) systems in health care settings. Yet little is known about their perceptions and confidence toward using such systems. This study explored nurses’ perceptions toward and confidence in using the EMR system. Predictors for confidence status in using the system among nurses were postulated.

Methods:

A cross-sectional survey design was used. A sample of 169 nurses were recruited from a general governmental university hospital in Muscat, Oman.

Results:

Most of study participants did not have prior experience with EMR systems elsewhere. About half (52.1%) perceived that they were confident in using the system. A logistic regression model showed nurses who (a) had six or more years of experience in using the system, (b) perceived that their suggestions regarding improving the system were taken into consideration by the system managing team, (c) perceived that the changes introduced in the system were important to their work, and (d) perceived that the information retrieved through the system was updated, to be more likely confident in using the system.

Discussion:

When customizing the EMR system, the informatics team that manages the system is invited to more consider suggestions for improvement that are raised by nurses. More training on the system is suggested to increase confidence among nurses who had little experience in using the system. In order to enhance the preparation of future nurses with contemporary technology-driven health care practices, nursing schools officials are encouraged to include general computer information technology training into nursing curricula.

Investigation of the Usability of Computerized Critical Care Information Systems in Germany

INTRODUCTION

The term "usability" describes how effectively, efficiently, and with what level of user satisfaction an information system can be used to accomplish specific goals. Computerized critical care information systems (CCISs) with high usability increase quality of care and staff satisfaction, while reducing medication errors. Conversely, systems lacking usability can interrupt clinical workflow, facilitate errors, and increase charting time. The aim of this study was to investigate and compare usability across CCIS currently used in Germany.

METHODS

In this study, German intensive care unit (ICU) nurses and physicians completed a specialized, previously validated, web-based questionnaire. The questionnaire assessed CCIS usability based on three rating models: an overall rating of the systems, a model rating technical usability, and a model rating task-specific usability.

RESULTS

We analyzed results from 535 survey participants and compared eight different CCIS commonly used in Germany. Our results showed that usability strongly differs across the compared systems. The system ICUData had the best overall rating and technical usability, followed by the platforms ICM and MetaVision. The same three systems performed best in the rating of task-specific usability without significant differences between each other. Across all systems, overall ratings were more dependent on ease-of-use aspects than on aspects of utility/functionality, and the general scope of the functions offered was rated better than how well the functions are realized.

DISCUSSION

Our results suggest that manufacturers should shift some of their effort away from the development of new features and focus more on improving the ease-of-use and quality of existing features.

Design and validation of a questionnaire to evaluate the usability of computerized critical care information systems

The implementation of computerized critical care information systems (CCIS) can improve the quality of clinical care and staff satisfaction, but also holds risks of disrupting the workflow with consecutive negative impacts. The usability of CCIS is one of the key factors determining their benefits and weaknesses. However, no tailored instrument exists to measure the usability of such systems. Therefore, the aim of this study was to design and validate a questionnaire that measures the usability of CCIS. Following a mixed-method design approach, we developed a questionnaire comprising two evaluation models to assess the usability of CCIS: (1) the task-specific model rates the usability individually for several tasks which CCIS could support and which we derived by analyzing work processes in the ICU; (2) the characteristic-specific model rates the different aspects of the usability, as defined by the international standard "ergonomics of human-system interaction". We tested validity and reliability of the digital version of the questionnaire in a sample population. In the sample population of 535 participants both usability evaluation models showed a strong correlation with the overall rating of the system (multiple correlation coefficients ≥0.80) as well as a very high internal consistency (Cronbach's alpha ≥0.93). The novel questionnaire is a valid and reliable instrument to measure the usability of CCIS and can be used to study the influence of the usability on their implementation benefits and weaknesses.

Development of a prehospital vital signs chart sharing system

OBJECTIVE

Physiological parameters are crucial for the caring of trauma patients. There is a significant loss of prehospital vital signs data of patients during handover between prehospital and in-hospital teams. Effective strategies for reducing the loss remain a challenging research area. We tested whether the newly developed electronic automated prehospital vital signs chart sharing system would increase the amount of prehospital vital signs data shared with a remote trauma center prior to hospital arrival.

METHODS

Fifty trauma patients, transferred to a level I trauma center in Japan, were studied. The primary outcome variable was the number of prehospital vital signs shared with the trauma center prior to hospital arrival.

RESULTS

The prehospital vital signs chart sharing system significantly increased the number of prehospital vital signs, including blood pressure, heart rate, and oxygen saturation, shared with the in-hospital team at a remote trauma center prior to patient arrival at the hospital (P < .0001). There were significant differences in prehospital vital signs during ambulance transfer between patients who had severe bleeding and non-severe bleeding within 24 hours after injury onset.

CONCLUSIONS

Vital signs data collected during ambulance transfer via patient monitors could be automatically converted to easily visible patient charts and effectively shared with the remote trauma center prior to hospital arrival. The prehospital vital signs chart sharing system increased the number of precise vital signs shared prior to patient arrival at the hospital, which can potentially contribute to better trauma care without increasing labor and reduce information loss during clinical handover.

Internal medicine progress note writing attitudes and practices in an electronic health record

BACKGROUND

The electronic health record (EHR) has been viewed with both praise and skepticism. Multiple editorials have expressed concerns that EHR implementation and "efficiency tools" such as copy forward and auto population have resulted in a decrement in note accuracy, relevance, and critical thinking.

OBJECTIVE

To evaluate the perceptions of internal medicine housestaff and attendings on inpatient progress note quality at 4 academic institutions after the implementation of an EHR.

DESIGN

Cross-sectional survey.

MEASUREMENTS

We developed surveys that assessed housestaff and attendings opinion of current progress note quality, the impact of the EHR on quality, and the purposes of a progress note.

RESULTS

We received 99 completed surveys from interns (66%), 155 from residents (49%), and 153 from attendings (70%) across 4 institutions. The majority of housestaff responded that the quality of notes was "unchanged" or "better" following the implementation of an EHR, whereas attendings believed note quality was "unchanged" or "worse." Attendings' perceptions of housestaff notes were significantly lower than housestaff perceptions of their own notes across all domains. With regard to the effect of copy forward and autopopulation, the majority of housestaff viewed these to be "neutral" or "somewhat positive," whereas attendings viewed these as "neutral" or "somewhat negative." Housestaff and attendings had nearly perfect agreement regarding the purpose of the progress note.

CONCLUSIONS

Attendings and housestaff disagree on the current quality of progress notes and the impact of an EHR on note quality, but agree on the purpose of a progress note.

The organizational and clinical impact of integrating bedside equipment to an information system: a systematic literature review of patient data management systems (PDMS)

OBJECTIVE

The introduction of an information system integrated to bedside equipment requires significant financial and resource investment; therefore understanding the potential impact is beneficial for decision-makers. However, no systematic literature reviews (SLRs) focus on this topic. This SLR aims to gather evidence on the impact of the aforementioned system, also known as a patient data management system (PDMS) on both organizational and clinical outcomes.

MATERIALS AND METHODS

A literature search was performed using the databases Medline/PubMed and CINHAL for English articles published between January 2000 and December 2012. A quality assessment was performed on articles deemed relevant for the SLR.

RESULTS

Eighteen articles were included in the SLR. Sixteen articles investigated the impact of a PDMS on the organizational outcomes, comprising descriptive, quantitative and qualitative studies. A PDMS was found to reduce the charting time, increase the time spent on direct patient care and reduce the occurrence of errors. Only two articles investigated the clinical impact of a PDMS. Both reported an improvement in clinical outcomes when a PDMS was integrated with a clinical decision support system (CDSS).

CONCLUSIONS

A PDMS has shown to offer many advantages in both the efficiency and the quality of care delivered to the patient. In addition, a PDMS integrated to a CDSS may improve clinical outcomes, although further studies are required for validation.

Rapid clinical evaluation: an early warning cardiac surgical scoring system for hand-held digital devices

OBJECTIVES

The purpose of this study was to develop a new scoring system for the prompt recognition of clinical deterioration and early treatment in postoperative cardiac surgical patients.

METHODS

All consecutive adult patients undergoing cardiac surgery between 1st January 2007 and 31st December 2010 were included. The new score was calculated daily until intensive care unit (ICU) discharge. The score consists of 11 variables representing six different organ systems. Performance was assessed using receiver-operating characteristic (ROC) curves and calibration tests.

RESULTS

A total of 5207 patients with a mean age of 67.2 ± 10.9 years were admitted to the ICU after cardiac surgery. The operations performed covered the whole spectrum of cardiac surgery. ICU mortality was 5.9%. The mean length of ICU stay was 4.6 ± 7.0 days. The new score had an excellent discrimination with areas under the ROC curves between 0.91 and 0.96. Calibration was also excellent reflected by observed/expected mortality ratios ranging between 1.0 and 1.26.

CONCLUSIONS

The new score is a simple and reliable scoring system to assess organ dysfunction in cardiac intensive care patients. It is designed especially for personal digital assistants to simplify and accelerate the process of risk stratification in cardiac surgical ICUs.

Prevalence of copied information by attendings and residents in critical care progress notes

OBJECTIVES

To determine the prevalence and mechanism of copying among ICU physicians using an electronic medical record.

DESIGN

Retrospective cohort study.

SETTING

Medical ICU of an urban, academic medical center.

PATIENTS

Two thousand sixty-eight progress notes of 135 patients generated by 62 residents and 11 attending physicians between August 1, 2009, and December 31, 2009.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

EIghty-two percent of all residents and 74% of all attending notes contained greater than or equal to 20% copied information (p = 0.001). Although residents authored more copied notes than attendings, residents copied less information between notes than attendings (55% vs. 61%, p < 0.001). Following greater than or equal to 1 day off, residents copied less often from their own prior notes compared to attendings (66% vs. 94%, p < 0.001). Of the copied information following a day off, there was no difference in the amount of information copied into notes of residents (59%) or attendings (61%, p = 0.17). In a regression model of attending notes, no patient factors were associated with copying. However, the levels of copying among attendings varied from 41% to 82% (p < 0.001).

CONCLUSIONS

Copying among attendings and residents was common in this ICU-based cohort, with residents copying more frequently and attendings copying more information per note. The only factor that was independently associated with attending copying was the attending. Further studies should focus on further elucidating the factors influencing copying in the ICU and the effects of copying on patient outcomes.

Contribuições dos registros eletrônicos para a segurança do paciente em terapia intensiva: uma revisão integrativa

Revisão integrativa que analisou nas publicações as contribuições dos registros eletrônicos em saúde para a segurança do paciente em unidades de terapia intensiva. A pesquisa foi realizada nas bases de dados CINAHL, MEDLINE e SciELO, utilizando os descritores: registros eletrônicos de saúde, sistemas de informação, informática em enfermagem, informática médica, unidades de terapia intensiva, segurança do paciente e gerenciamento de segurança. Foram incluídos 64 artigos, sendo analisados em três categorias: "sistemas de informação e informática em saúde: o registro eletrônico para a continuidade do cuidado de Enfermagem", "sistemas de apoio à decisão: contribuições para a segurança do paciente" e "indicadores de qualidade do cuidado e de segurança do paciente partir dos registros eletrônicos". Os estudos apontaram como contribuições a continuidade do cuidado, a tomada de decisão baseada nos sistemas de apoio à decisão e a criação de indicadores de qualidade e segurança do paciente a partir dos registros eletrônicos.

How to implement information technology in the operating room and the intensive care unit

The number of operating rooms and intensive care units looking for a data management system to perform their increasingly complex tasks is rising. Although at this time only a minority is computerized, within the next few years many centres will start implementing information technology. The transition towards a computerized system is a major venture, which will have a major impact on workflow. This chapter reviews the present literature. Published papers on this subject are predominantly single- or multi-centre implementation reports. The general principles that should guide such a process are described. For healthcare institutions or individual practitioners that plan to undertake this venture, the implementation process is described in a practical, nine-step overview.

Impact of computerized information systems on workload in operating room and intensive care unit

The number of operating rooms and intensive care departments equipped with a clinical information system (CIS) is rapidly expanding. Amongst the putative advantages of such an installation, reduction in workload for the clinician is one of the most appealing. The scarce studies looking at workload variations associated with the implementation of a CIS, only focus on direct workload discarding indirect changes in workload. Descriptions of the various methods to quantify workload are provided. The hypothesis that a third generation CIS can reduce documentation time for ICU nurses and increase time they spend on patient care, is supported by recent literature. Though it seems obvious to extrapolate these advantages of a CIS to the anesthesiology department or physicians in the intensive care, studies examining this assumption are scarce.

The impact of a Critical Care Information System (CCIS) on time spent charting and in direct patient care by staff in the ICU: a review of the literature

PURPOSE

The introduction of a Critical Care Information System (CCIS) into an intensive care unit (ICU) is purported to reduce the time health care providers (HCP) spend on documentation and increase the time available for direct patient care. However, there is a paucity of rigorous empirical research that has investigated these assertions. Moreover, those studies that have sought to elucidate the relationship between the introduction of a CCIS and the time spent by staff on in/direct patient care activities have published contradictory findings. The objective of this literature review is to establish the impact of a CCIS on time spent documenting and in direct patient care by staff in the ICU.

METHODS

Five electronic databases were searched including PubMed Central, EMBASE, CINAHL, IEEE Xplore, and the Cochrane Database of Systematic Reviews. Reference lists of all published papers were hand searched, and citations reviewed to identify extra papers. We included studies that were empirical articles, published in English, and provided original data on the impact of a CCIS on time spent documenting and in direct patient care by staff in the ICU.

RESULTS

In total, 12 articles met the inclusion criteria. Workflow analysis (66%) and time-and-motion analysis (25%) were the most common forms of data collection. Three (25%) studies found an increase in time spent charting, five (42%) found no difference, and four (33%) studies reported a decrease. Results on the impact of a CCIS on direct patient care were similarly inconclusive.

CONCLUSIONS

Due to the discrepant findings and several key methodological issues, the impact of a CCIS on time spent charting and in direct patient care remains unclear. This review highlights the need for an increase in rigorous empirical research in this area and provides recommendations for the design and implementation of future studies.