Changes in intensive care unit nurse task activity after installation of a third-generation intensive care unit information system

Abstract

OBJECTIVE To determine the percentage of time that intensive care unit (ICU) nurses spend on documentation and other nursing activities before and after installation of a third-generation ICU information system.

Design: Prospective data collection using real-time time-motion analysis, before and after installation of the ICU information system.

Setting: A ten-bed surgical ICU at a Veterans Affairs medical center.

Subjects: ICU nurses.

Interventions: Installation of a third-generation ICU information system.

Measurements and main results: Ten ICU nurses were studied before and after installation of the ICU information system. Each ICU nurse's activities and tasks, during 4-hr observation periods, were categorized in real-time by a nurse observer and recorded in a laptop computer. Each recorded task was automatically time-stamped and logged into a data file. The percentage of time spent on documentation decreased from 35.1 +/- 8.3% to 24.2 +/- 7.6% (p =.025) after the ICU information system was installed. The percentage of time providing direct patient care increased from 31.3 +/- 9.2% to 40.1 +/- 11.7% (p =.085). The percentage of time doing patient assessment, a direct patient care task, increased from 4.0 +/- 4.7% to 9.4 +/- 4.4% (p =.001).

Conclusions: Installation of a third-generation ICU information system decreased the percentage of time ICU nurses spent on documentation by >30%. Almost half of the time saved on documentation was spent on patient assessment, a direct patient care task.