Time Motion Study in a Pediatric Emergency Department Before and After Computer Physician Order Entry
Presented as a platform presentation at the 2007 Pediatric Academic Societies annual meeting, May 2007, Toronto, Ontario, Canada; and as a poster session at the 2005 PAS annual meeting, May 2005, Washington, DC.
Received 24 March 2008; received in revised form 16 July 2008 and 24 August 2008; accepted 8 September 2008. published online 21 November 2008.
Study objective
To determine the effect of computer physician order entry on pediatric emergency department (ED) care providers allocation of time. We seek to determine whether the increase in time by ED care providers on the computer will decrease time spent with patients.
Methods
This was a before-and-after observational time-and-motion study conducted at an urban pediatric ED. Observers recorded how caregivers allocated their time during 180-minute observation periods at 30-second increments the summers before after computer physician order entry introduction. Time on the computer was recorded in seconds. Observations were placed into 3 categories (direct patient care, indirect patient care, other), each with its own subcategories.
Results
For attending physicians, median computer time increased from 5.0 minutes before computer physician order entry to 9.5 minutes after computer physician order entry (P=.01). For resident physicians, median computer time increased from 5.5 minutes before computer physician order entry to 14.3 minutes after computer physician order entry (P=.001). For nurses, time on the computer was not significantly different before and after computer physician order entry (P=.15), although it appears there was still some change in time allocation. After computer physician order entry, nurses' talking with staff about patient care decreased from 24.5 minutes to 13.3 minutes (P=.01). Computer physician order entry did not decrease time with patients for any of the caregiver types.
Conclusion
The addition of computer physician order entry to a pediatric ED increases time spent on the computer by both attending and resident physicians but not for emergency nurses. This additional time on the computer is allocated from nonpatient care activities. The addition of computer physician order entry decreases nurses' time talking with other staff for patient care.
aDepartment of Pediatrics, Section of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI
bChildren's Research Institute, Children's Hospital and Health System, Milwaukee, WI
Address for correspondence: Kenneth Yen, MD, MS, Children's Corporate Center, Pediatric Emergency Medicine, 999 N 92nd Street, Suite C550, Milwaukee, WI 53226; 414-266-3190, fax 414-266-2635
Supervising editor: Donald M. Yealy, MD
Author contributions: KY and MHG conceived and designed the study and performed the statistical analysis. KY trained the observers, supervised the conduct of the study (including quality control), and performed the data entry. ELS, SSP, NDS, and RJZ recruited participants and recorded the data. KY, ELS, and MHG performed substantial revisions of the article. All authors take responsibility for the paper as a whole.
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement.
Publication dates: Available online November 20, 2008.
ABSTRACT