EFFECT OF COMPUTERIZED CHARTING ON NURSING ACTIVITY IN INTENSIVE-CARE

Objective: To measure the impact on nursing activity of introducing computerized medical records into intensive care units (ICUs). Design: Prospective data collection monitoring the activity of ICU nurses before and after installation of a computerized charting system. Setting: A six-bed coronary care unit and an eight-bed medical ICU at the Minneapolis VA Medical Center. Subjects: Registered nurses providing intensive care services. Interventions: Installation of a Clinical Information System that computerized the ICU medical records. Measurements and Main Results: Before computer installation, nurses spent 24% of their time manipulating data (7% gathering and 17% charting), After installation, charting time decreased to 10%, and data gathering time decreased to 4%, while 10% of time was spent at computer terminals entering or reviewing data, The total time manipulating data postinstallation was thus 24% (i.e., unchanged from previous), Computerized charting did not alter time spent in patients' rooms (43% pre- and 43% postinstallation) compared with time spent at the central station (37% pre- and 36% postinstallation) or elsewhere (20% pre- and 21% postinstallation), Relative time spent at various tasks varied between units and from shift to shift, but the net effect of computerized charting was that nurses had more time available at the central station for monitoring, and that the computer terminals were used primarily in the patient rooms. Conclusions: Computerized charting will not necessarily provide ICU nurses with a net excess of time for tasks unrelated to manipulating data.