A ward-based time study of paper and electronic documentation for recording vital sign observations.
OBJECTIVE
To investigate time differences in recording observations and an early warning score using traditional paper charts and a novel e-Obs system in clinical practice.


METHODS
Researchers observed the process of recording observations and early warning scores across 3 wards in 2 university teaching hospitals immediately before and after introduction of the e-Obs system. The process of recording observations included both measurement and documentation of vital signs. Interruptions were timed and subtracted from the measured process duration. Multilevel modeling was used to compensate for potential confounding factors.


RESULTS
In all, 577 nurse events were observed (281 paper, 296 e-Obs). The geometric mean time to take a complete set of vital signs was 215 s (95% confidence interval [CI], 177 s-262 s) on paper, and 150 s (95% CI, 130 s-172 s) electronically. The treatment effect ratio was 0.70 (95% CI, 0.57-0.85, P  < .001). The treatment effect ratio in ward 1 was 0.37 (95% CI, 0.26-0.53), in ward 2 was 0.98 (95% CI, 0.70-1.38), and in ward 3 was 0.93 (95% CI, 0.66-1.33).


CONCLUSIONS
Introduction of an e-Obs system was associated with a statistically significant reduction in overall time to measure and document vital signs electronically compared to paper documentation. The reductions in time varied among wards and were of clinical significance on only 1 of 3 wards studied.


CONCLUSIONS
Our results suggest that introduction of an e-Obs system could lower nursing workload as well as increase documentation quality.
Yorkshire Centre for Health Informatics, Leeds Institute of Data Analytics, Worsley Building, University of Leeds, Leeds, UK.
David
D
Wong
Kadoorie Centre for Critical Care Research and Education, John Radcliffe Hospital, Oxford, UK.
Timothy
T
Bonnici
Kadoorie Centre for Critical Care Research and Education, John Radcliffe Hospital, Oxford, UK.
Julia
J
Knight
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Stephen
S
Gerry
Brasenose College, University of Oxford, Oxford, UK.
James
J
Turton
Kadoorie Centre for Critical Care Research and Education, John Radcliffe Hospital, Oxford, UK.
Peter
P
Watkinson
D004282:Documentation / Q000379:methods*; D004526:Efficiency; D057286:Electronic Health Records; D006785:Hospitals, University; D006801:Humans; D009737:Nursing Records; D010362:Patients' Rooms / Q000458:organization & administration; D013997:Time Factors; D013996:Time and Motion Studies; D055986:Vital Signs
early warning score; electronic charting; time and motion studies; vital signs