International Journal of Medical Informatics
Volume 78, Issue 7 , Pages 435-445 , July 2009

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

  • Rebecca L. Mador
  • ,
  • Nicola T. Shaw

      Affiliations

    • Corresponding Author InformationCorresponding author at: Health Informatics, 3rd Floor Environmental Engineering Bldg., University of Alberta, 112 Street & 87 Avenue, Edmonton, Alberta, Canada T6G 2M8. Tel.: +1 780 492 3185; fax: +1 780 492 2471.

Received 23 September 2008 ,Revised 17 January 2009 ,Accepted 26 January 2009.

References 

  1. Alberta Health and Wellness, Vision 2020, The Future of Health Care in Alberta, Canada, Phase One, December 2008, p. 13.
  2. Rosenberg DI, Moss M. Section on Critical Care and Committee on Hospital Care, Guidelines and levels of care for pediatric intensive care units. Pediatrics. 2004;114(4):1114–1125
  3. Noble MA. The critical care clinical nurse specialist: need for hospital and community. Clin. Nurse Spec. 1988;2(1):30–33
  4. Sado AS. Electronic medical record in the intensive care unit. Crit. Care Clin. 1999;15(July (3)):499–522
  5. Dasta JF. Computers in critical care: opportunities and challenges. DICP. 1990;24:1084–1092
  6. Marasovic C, Kenney C, Elliott D, Sindhusake D. Attitudes of Australian nurses toward the implementation of a clinical information system. Comput. Nurs. 1997;15(2):91–98
  7. Garland A. Improving the ICU: part 2. Chest. 2005;127(6):2165–2179
  8. Varon J, Marik PE. Clinical information systems and the electronic medical record in the intensive care unit. Curr. Opin. Crit. Care. 2002;8(December (6)):616–624
  9. McGrath F, Morgenweck L. Rebuilding a clinical workstation with spider's silk of the web. Bull. Med. Libr. Assoc. 1999;87(4):387–392
  10. Fraenkel D, Cowie M, Daley P. Quality benefits of an intensive care clinical information system. Crit. Care Med. 2003;31(1):120–125
  11. Baker A, Bokovoy J, Soete R, Matchett S. Adopting technology to enhance patient care. Am. J. Crit. Care. 2006;15(3):331
  12. Wong DH, Gallegos Y, Weinger MB, Clack S, Slagle J, Anderson CT. Changes in intensive care unit nurse task activity after installation of a third-generation intensive care unit information system. Crit. Care Med. 2003;31(10):2488–2494
  13. Marasovic C, Kenney C, Elliott D, Sindhusake D. A comparison of nursing activities associated with manual and automated documentation in an Australian intensive care unit. Comput. Nurs. 1997;15(July (4)):205–211
  14. Pierpont GL, Thilgen D. Effect of computerized charting on nursing activity in intensive care. Crit. Care Med. 1995;23(June (6)):1067–1073
  15. Saarinen K, Aho M. Does the implementation of a clinical information system decrease the time intensive care nurses spend on documentation of care?. Acta Anaesthesiol. Scand. 2005;49:62–65
  16. Makoul G, Curry RH, Tang PC. The use of electronic medical records: communication patterns in outpatient encounters. J. Am. Med. Inform. Assoc. 2001;8:610–615
  17. Kovner C, Schuchman L, Mallard C. The application of pen-based computer technology to home health care. Comput. Nurs. 1997;15:237–244
  18. Pabst MK, Scherubel JC, Minnick AF. The impact of computerized documentation on nurses’ use of time. Comput. Nurs. 1996;14:25–30
  19. Hammer JS, Strain JJ, Friedberg A, Fulop G. Operationalizing a bedside pen entry notebook clinical database system in consultation-liaison psychiatry. Gen. Hosp. Psychiatry. 1995;17:165–172
  20. Poissant L, Pereira J, Tamblyn R, Kawasumi Y. The impact of electronic health records on time efficiency of physicians and nurses: a systematic review. J. Am. Med. Inform. Assoc. 2005;12(5):505–516
  21. Gugerty B., Testing the effects of process improvement and a critical care clinical information system on selected nurse attitudes, toward team function and performance, nurse process variables, and patient outcomes, State University of New York, Buffalo, 1998.
  22. Petticrew M, Roberts H. Systematic Reviews in the Social Sciences. Oxford: Blackwell Publishing Ltd.; 2006;
  23. Effective Public Health Practice Project (EPHPP), Quality Assessment Tool for Quantitative Studies, 2008, available from http://www.myhamilton.ca/myhamilton/CityandGovernment/HealthandSocialServices/Research/EPHPP.
  24. Deeks JJ, Dinnes J, D’Amico R, Sowden AJ, Sakarovitch C, Song F, et al. Evaluating non-randomised intervention studies. Health Technol. Assess. 2003;22
  25. Apkon M, Singhaviranon P. Impact of an electronic information system on physician workflow and data collection in the intensive care unit. Intensive Care Med. 2001;27:122–130
  26. Menke JA, Broner CW, Campbell DY, McKissick MY, Edwards-Beckeet JA. Computerized clinical documentation system in the pediatric intensive care unit. BMC Med. Inform. Decis. Mak. 2001;1(3):
  27. Kilgore ML, Flind D, Pearce R. The varying impact of two clinical information systems in a cardiovascular intensive care unit. J. Cardiovasc. Manag. 1998;9:31–35
  28. Allen D, Davis M. A computerized CIS enhances bedside intensive care. Nurs. Manage. 1992;112I–120I
  29. Bosman RJ, Rood E, Oudemans-van Straaten HM, Van der Spoel JI, Wester JPJ, Zandstra DF. Intensive care information system reduces documentation time of the nurses after cardiothoracic surgery. Intensive Care Med. 2003;29:83–90
  30. Gugerty B, Wooldridge P, Brennan M. The CISQ: a tool to measure staff involvement in and attitudes toward the implementation of a clinical information system. 2000;
  31. Westbrook J.I., Ampt A., Kearney L., Work Observation Method by Activity Timing (WOMBAT) Manual, Health Informatics Research & Evaluation Unit, University of Sydney, 2007.
  32. Ampt A, Westbrook J, Creswick N, Mallock N. A comparison of self-reported and observational work sampling techniques for measuring time in nursing tasks. J. Health Serv. Res. Policy. 2007;12(1):18–24
  33. Finkler SA, Knickman JR, Hendrickson G, Lipkin , Thompson WG. A comparison of work-sampling and time-and-motion techniques for studies in health services research. Health Serv. Res. 1993;28:577–597
  34. Pelletier D, Duffield C. Work sampling: Valuable Methodology to Define Nursing Practice Patterns. 2003;pp. 31–38
  35. Urden LD, Roode JL. Work sampling: a decision-making tool for determining resources and work redesign. J. Nurs. Adm. 1997;27:34–41
  36. Malhotra S, Jordan D, Shortliffe E, Patel VL. Workflow modeling in critical care: piecing together your own puzzle. J. Biomed. Inform. 2007;40:81–92
  37. Westbrook JL, Ampt A, Williamson M, Nguyen K, Kearney L. Methods of Measuring the Impact of Health Information Technologies on Clinicians’ Patterns of Work and Communication. 2007;
  38. Mador RL, Shaw NT, Mayes D. Interruptions in workflow prior to the implementation of a Critical Care Information System (CCIS) in two intensive care settings. AMIA Annu. Symp. Proc. 2008;1037
  39. Mador RL, Shaw NT, Mayes D, Westbrook JI, Creswick N, Thiru K, et al. Understanding Workflow and Interruptions in Pediatric Intensive Care Prior to the Introduction of a Critical Care Information System, Information Technology and Communication in Health (ITCH).. 2009;
  40. Tahan HA. Information systems enhance efficient and effective nursing practice and management. Semin. Nurs. Manag. 2002;10(2):76–79
  41. Shabot MM. Integrating information systems for enhanced efficacy and outcomes management. Healthc. Inf. Manage. 1993;7(4):27–31
  42. Hendrickson G, Kovner CT. Effects of computers on nursing resource use. Comput. Nurs. 1990;8(1):16–22
  43. Bria WF, Shabot MM. The electronic medical record, safety, and critical care. Crit. Care Clin. 2005;21(1):55–79
  44. Bradshaw KE, Sittig DF, Gardner RM, Pryor TA, Budd M. Computer-based data entry for nurses in the ICU. MD Comput. 1989;6(5):274–280
  45. Donati A, Gabbanelli V, Pantanetti S, Carletti P, Princip T, Marini B, et al. The impact of a clinical information system in an intensive care unit. J. Clin. Monit. Comput. 2008;22:31–36
  46. Salyer PD. A Meta-Analysis of Work Sampling Studies Pre- and Post-Implementation of Bedside Computer Charting in Intensive Care Units. Texas Women's University; 1994;

 All opinions asserted here are those of the authors and not necessarily those of the organizations mentioned above, or that of their employers.

PII: S1386-5056(09)00015-X

doi: 10.1016/j.ijmedinf.2009.01.002

International Journal of Medical Informatics
Volume 78, Issue 7 , Pages 435-445 , July 2009