目的:电子病历(EMR)简化了卫生保健专业人员的工作流程,然而,他们的全部潜力并不总是得到实现。现代EMR通常能够生成自动预填充的住院患者列表,但是,如果这些功能不适用于住院团队或未考虑最终用户的设计,住院医生可能会被留下来创造替代方案,手动解决方案,以确保可靠和高效的护理。本研究的目的是纵向比较手动和自动住院患者名单对住院医师教育的影响,健康,和患者安全。
方法:在3年的时间里,对I级创伤中心的骨科外科住院医师进行了回顾性标准化调查,以评估与EMR变化相一致的各种自动和手动列表迭代的影响。收集的数据包括研究生年(PGY)状态,到达工作时间,每天花费的时间准备和更新列表,感知到对患者安全的影响,居民工作量,教育,和睡眠。我们使用非配对t检验和卡方检验比较了手动和自动列表数据。
方法:这项研究是在布鲁克陆军医疗中心进行的,圣安东尼奥的一个一级创伤中心,德克萨斯州。这是一个学术医疗中心和国防部最大的医疗设施。
方法:共收集了33名各级培训骨科住院医师的71项调查。
结果:自动列表(n=17)早上的实习生列表准备时间为27±16分钟,而手动列表(n=23)为72±21分钟(p<0.0001)。实习生全天更新列表的总时间平均为自动列表(n=17)83分钟,而手动列表(n=23)为196分钟(p<0.0001)。此外,86%的实习生认为在手册列表上花费的时间影响了他们的教育,96%的人表示它直接影响了他们必须学习的时间,100%的人同意它对他们的睡眠产生负面影响(n=23)。只有48%的实习生(n=23)对手动列表的表现感到满意,而对自动列表的满意度为94%(n=17)。Further,87%的实习生认为手动列表对患者护理产生了负面影响,并对他们的工作满意度产生了负面影响。相比之下,59%的实习生认为自动列表提高了他们的工作满意度。最终,对于实习生来说,自动列表与手动列表相比,每天可以为他们提供额外的106分钟教育时间,睡眠,或其他活动。PGY2居民及以上居民在使用清单的经验方面也注意到了类似的趋势。
结论:根据我们的研究确定,使用自动住院患者列表的好处是提高了早晨的效率,减少了全天的准备和维护。此外,有了自动列表,有了更多的教育和睡眠时间,提高工作满意度。最重要的是,受访者认为,与手动列表相比,自动列表对患者护理更安全。这应该迫使进一步的研究和努力,以改善医院的自动EMR跟踪列表。总之,与自动电子病历住院患者名单相比,手册列表导致一整天的准备时间和维护时间大大增加,从而对居民的教育和生活质量产生负面影响,同时引起了对患者安全的担忧。
OBJECTIVE: Electronic medical records (EMRs) have streamlined workflows for health care professionals, yet their full potential is not always actualized. Modern EMRs are often capable of generating
automated prepopulated inpatient lists, however if these capabilities are not made available to inpatient teams or not designed with the end user in mind, resident physicians may be left to create alternative, manual solutions to ensure reliable and efficient care. The purpose of the current study was to longitudinally compare the impact of both manual and
automated inpatient lists on resident education, wellness, and patient safety.
METHODS: Retrospective standardized surveys were administered to resident physicians in the orthopedic surgery department at a level I trauma center over a 3-year period to evaluate the impact of various automated and manual list iterations coinciding with changes to the EMR. Data collected included post graduate year (PGY) status, arrival time to work, daily time spent preparing and updating the list, perceived impact on patient safety, resident workload, education, and sleep. We compared manual versus
automated list data with unpaired t-tests and chi-squared tests.
METHODS: The study was conducted at Brooke Army Medical Center, a level 1 trauma center in San Antonio, Texas. It is an Academic Medical Center and the Department of Defense\'s largest medical facility.
METHODS: A total of 71 surveys were collected from 33 orthopedic surgery residents in all levels of training.
RESULTS: Intern list prep time in the morning was 27 ± 16 minutes for the
automated list (n = 17) vs 72 ± 21 minutes for the manual lists (n = 23) (p < 0.0001). Total time spent by interns updating the list for the entire day was on average 83 minutes for the automated list (n = 17) vs 196 minutes for the manual lists (n = 23) (p < 0.0001). In addition, 86% of interns felt the time spent on the manual list impacted their education, with 96% stating that it directly impacted the amount of time they had to study and 100% agreed that it negatively impacted their sleep (n = 23). Only 48% of interns (n = 23) were satisfied with the performance of the manual lists compared to 94% satisfaction (n = 17) with the automated list. Further, 87% of interns felt the manual list negatively impacted patient care and negatively affected their job satisfaction. In comparison, 59% of interns felt the
automated list improved their job satisfaction. Ultimately, for an intern an automated list versus a manual list affords them an extra 106 minutes per day for education, sleep, or other activities. PGY2 residents and above noted similar trends regarding their experience with the lists.
CONCLUSIONS: The benefits of utilizing automated inpatient lists as determined by our study are improved efficiency in the morning with less preparation and maintenance throughout the day. Additionally, with automated lists there was more perceived time for education and sleep, with improved job satisfaction. Most importantly, respondents felt that automated lists were safer for patient care when compared to manual lists. This should compel further research and efforts into improving automated EMR tracking lists in hospitals. In summary, as compared to the automated electronic medical record inpatient list, manual lists resulted in substantially more preparation time and maintenance throughout the day thereby negatively impacting resident education and quality of life, while raising concerns for patient safety.