Intensive Care Unit Nurse Workflow During Shift Change Prior to the Introduction of a Critical Care Clinical Information System

Nicola T Shaw, Mark A Ballermann, Reidar Hagtvedt, Sally Ho, Damon C Mayes, Noel Gibney


Background: A Critical Care clinical Information System (CCIS) is an electronic charting tool which may improve informational continuity between Health Care Providers (HCPs) in Intensive Care Units (ICUs). Methods: To begin to test this assertion, we examined Registered Nurse (RN) workflow at two ICUs, prior to a CCIS introduction. Research observers followed RNs and recorded tasks with Personal Digital Assistants. We report percentages of time spent on documentation tasks, patient care, and professional communication from 30 minutes before to 60 minutes after shift change. Proportions of time spent on each task were compared to overall percentages of time spent on each task category. Results: We found increases above the expected percentages of time spent on documentation before morning (07:00) shift change between 06:35 and 06:40. Between 06:50 and 06:55, RNs spent increased proportions of time on patient care. Significant increases in professional communication were found during the verbal communication portion of the handoff, just after 07:00. A second increase in time spent on patient care tasks was found between 07:35 and 07:50. Surrounding evening shift changes, there were smaller, but similar increases in time spent on professional communication and patient care tasks, but not documentation tasks. Conclusion: We suggest the RN workflow pattern around shift change illustrates that methods employed to ensure informational continuity may be improved. Future Directions: The CCIS introduction is likely to impact workflow patterns at shift changes. Future studies will present data obtained from RNs and other health care providers following the implementation of the CCIS.


Handoff; Informational Continuity; Continuity of Care; Critical Care Information System

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