Background: Patient safety literature has long reported the need for early recognition of deteriorating patients. Early warning scores (EWSs) are commonly implemented as "track and trigger," or rapid response systems for monitoring and early recognition of acute patient deterioration. This study presents a human factors evaluation of a hospital-wide transformation in practice, engendered by the deployment of an innovative electronic observations (eObs) and handover system. This technology enables real-time information processing at the patient's bedside, improves visibility of patient data, and streamlines communication within clinical teams.
Objective: The aim of this study was to identify improvement and deterioration in workplace efficiency and quality of care resulting from the large-scale imposition of new technology.
Methods: A total of 85 hours of direct structured observations of clinical staff were carried out before and after deployment. We conducted 40 interviews with a range of clinicians. A longitudinal analysis of critical care audit and electronically recorded patient safety incident reports was conducted. The study was undertaken in a large secondary-care facility in the United Kingdom.
Results: Roll-out of eObs was associated with approximately 10% reduction in total unplanned admissions to critical care units from eObs-equipped wards. Over time, staff appropriated the technology as a tool for communication, workload management, and improving awareness of team capacity. A negative factor was perceived as lack of engagement with the system by senior clinicians. Doctors spent less time in the office (68.7% to 25.6%). More time was spent at the nurses' station (6.6% to 41.7%). Patient contact time was more than doubled (2.9% to 7.3%).
Conclusions: Since deployment, clinicians have more time for patient care because of reduced time spent inputting and accessing data. The formation of a specialist clinical team to lead the roll-out was universally lauded as the reason for success. Staff valued the technology as a tool for managing workload and identified improved situational awareness as a key benefit. For future technology deployments, the staff requested more training preroll-out, in addition to engagement and support from senior clinicians.
Keywords: clinical deterioration; early warning score; health information technology; mixed methods; mobile health; patient safety; staff workload.
©Alexandra Lang, Mark Simmonds, James Pinchin, Sarah Sharples, Lorrayne Dunn, Susan Clarke, Owen Bennett, Sally Wood, Caron Swinscoe. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 06.03.2019.