title: Workflow in intensive care unit remote monitoring: A time-and-motion study.
abstract: OBJECTIVE
  To investigate workflow in intensive care unit remote monitoring, a technology-driven practice that allows critical care specialists to perform proactive and continuous patient care from a remote site.
  
  
  METHODS
  A time-and-motion study.
  
  
  METHODS
  Facility that remotely monitored 132 beds in nine intensive care units.
  
  
  METHODS
  Six physicians and seven registered nurses.
  
  
  METHODS
  Participants were observed for 47 and 39 hrs, respectively.
  
  
  RESULTS
  Clinicians' workflow was analyzed as goal-oriented tasks and activities. Major variables of interest included the times spent on different types of tasks and activities, the frequencies of accessing various information resources, and the occurrence and management of interruptions in workflow. Physicians spent 70%, 3%, 3%, and 24% of their time on patient monitoring, collaboration, system maintenance, and administrative/social/personal tasks, respectively. For nurses, the time allocations were 46%, 3%, 4%, and 17%, respectively. Nurses spent another 30% of their time maintaining health records. In monitoring patients, physicians spent more percentage times communicating with others than the nurses (13% vs. 7%, p = .026) and accessed the in-unit clinical information system more frequently (42 vs. 14 times per hour, p = .027), while nurses spent more percentage times monitoring real-time vitals (16% vs. 2%, p = .012). Physicians' and nurses' workflows were interrupted at a rate of 2.2 and 7.5 times per hour (p < .001), with an average duration of 101 and 45 secs, respectively (p = .006). The sources of interruptions were significantly different for physicians and nurses (p < .001).
  
  
  CONCLUSIONS
  Physicians' and nurses' task performance and information utilization reflect the distributed nature of work organization in intensive care unit remote monitoring. Workflow interruption, clinical information system usability, and collaboration with bedside caregivers are the major issues that may affect the quality and efficiency of clinicians' work in this particular critical care setting.
authors.affiliation: School of Health Information Sciences, University of Texas Health Science Center at Houston, USA. Zhihua.Tang@uth.tmc.edu
authors.forename: Zhihua
authors.initials: Z
authors.lastname: Tang
authors.forename: Liza
authors.initials: L
authors.lastname: Weavind
authors.forename: Janine
authors.initials: J
authors.lastname: Mazabob
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Thomas
authors.forename: Ming Ying L
authors.initials: MY
authors.lastname: Chu-Weininger
authors.forename: Todd R
authors.initials: TR
authors.lastname: Johnson
mesh_terms: D007362:Intensive Care Units / Q000458:organization & administration*; D009726:Nurses / Q000706:statistics & numerical data; D010820:Physicians / Q000706:statistics & numerical data; D017216:Telemedicine; D013996:Time and Motion Studies