The Key to Success: Replacing Small Keyboards Improves Use and Usability of Hospital Workstations on Wheels

Background In an increasingly digitised health service, little thought is given to the peripherals that doctors and other health professionals rely on to interface with computers to access the electronic patient record (EPR). While studies have shown how EPR design contributes to usability, similar work has not been undertaken to understand how computer hardware affects doctors' usage in the clinical setting. Methods A quality improvement project was conducted between December 2023 and May 2025 at a university hospital in the southwest of England. Resident doctors and medical students evaluated the accuracy and typing speed of keyboards currently used across the hospital. These keyboards varied by dimensions, key operating force, horizontal and vertical key spacing and key travel distance. The poorest-performing keyboards were replaced with better-performing models. The impact was evaluated by pre- and post-intervention surveys of resident doctors and statistical process control (SPC) analysis of login and note-writing statistics extracted from the EPR. Results The Man and Machine Its Cool Keyboard was the most accurate and fastest to type on but was no longer purchased by the hospital as they were frequently replaced. The Aitmon ATM-SK413 and Kinetic-ID Touch were the poorest-performing keyboards. These were the smallest keyboards and had smaller horizontal and vertical key spacing than other devices. Replacement of the latter two keyboards with a better-performing alternative resulted in increased usage of these upgraded workstations on medical wards: doctors used these computers for longer to write more notes. There was no change in the use of altered workstations on surgical wards, likely reflecting different working practices. The post-intervention survey demonstrated a reduction in the proportion of doctors reporting poor-performing keyboards.  Discussion and conclusion Smaller keyboards with smaller key spacing have a detrimental impact on workstation usability and staff satisfaction. Replacing these results in a more balanced use of the IT estate. The fact that a significant minority of respondents still report poor quality keyboards may indicate that users dislike silicone covers on keyboards. As well as keyboard size and key spacing, hospitals should conduct end-user trials of computer peripherals prior to large purchases and may want to consider the equipoise between usability and infection control when rolling out and maintaining IT peripherals for the EPR.