Time motion study in a pediatric emergency department before and after computer physician order entry

Area of Science:

• Health Informatics
• Pediatric Emergency Medicine
• Healthcare Operations

Background:

• Electronic health records and physician order entry systems are increasingly adopted in healthcare settings.
• Understanding the impact of these systems on clinical workflows and time allocation is crucial for efficient patient care.

Purpose of the Study:

• To evaluate the effect of implementing computer physician order entry (CPOE) on the time allocation of healthcare providers in a pediatric emergency department (ED).
• To determine if increased CPOE use by ED providers reduces time spent directly with patients.

Main Methods:

• A before-and-after observational time-and-motion study was conducted in an urban pediatric ED.
• Observers recorded caregiver time allocation in 30-second increments during 180-minute periods before and after CPOE implementation.
• Time was categorized into direct patient care, indirect patient care, and other activities.

Main Results:

• Median computer time for attending physicians increased from 5.0 to 9.5 minutes (P=.01), and for resident physicians from 5.5 to 14.3 minutes (P=.001).
• Nurse computer time showed no significant change (P=.15), but their time spent talking with staff about patient care decreased from 24.5 to 13.3 minutes (P=.01).
• CPOE implementation did not decrease overall time spent with patients for any provider type.

Conclusions:

• CPOE increases computer time for physicians (attending and resident) in pediatric EDs, but not for nurses.
• The additional physician computer time is reallocated from non-patient care activities.
• CPOE implementation leads to reduced inter-staff communication time for nurses regarding patient care.