title: 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.
abstract: OBJECTIVE
  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.
authors.affiliation: University of Alberta, Faculty of Medicine & Dentistry, Department of Medicine, Edmonton, AB, Canada.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Mador
authors.forename: Nicola T
authors.initials: NT
authors.lastname: Shaw
mesh_terms: D003422:Critical Care; D016208:Databases, Factual; D020000:Decision Support Systems, Clinical; D004282:Documentation; D006751:Hospital Information Systems / Q000592:standards*; D006801:Humans; D007362:Intensive Care Units; D016347:Medical Records Systems, Computerized; D010347:Patient Care Planning / Q000458:organization & administration*; D010561:Personnel Staffing and Scheduling; D000078329:Workforce; D016526:Workload