Doctors documenting: an ethnographic and informatics approach to understanding attending physician documentation in the pediatric emergency department.
Objective: The pediatric emergency department is a highly complex and evolving environment. Despite the fact that physicians spend a majority of their time on documentation, little research has examined the role of documentation in provider workflow. The aim of this study is to examine the task of a...
| Published in: | Journal of the American Medical Informatics Association Vol. 28; no. 2; pp. 239 - 249 |
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| Main Authors: | , , , |
| Format: | research Journal Article |
| Published: |
Oxford University Press / USA
Feb2021
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=148717893&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 148717893 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10675027 FZ9 jtl: Journal of the American Medical Informatics Association issn: 10675027 maglogo: N pubinfo: dt: Feb2021 vid: 28 iid: 2 pid: 622 pub: Oxford University Press / USA artinfo: ui: 148717893 148717893 NLM33175154 148717893 10.1093/jamia/ocaa252 NLM33175154 148717893 ppf: 239 ppct: 10 formats: tig: atl: Doctors documenting: an ethnographic and informatics approach to understanding attending physician documentation in the pediatric emergency department. aug: au: Fouquet, Sarah D Fitzmaurice, Laura Chan, Y Raymond Palmer, Evan M affil: Human Factors Collaborative, Children's Mercy Hospital Kansas City , Kansas City, Missouri, USA sug: subj: Pediatrics Medical Staff, Hospital Emergency Service Administration Documentation Systems Analysis Task Performance and Analysis Anthropology, Cultural Child Clinical Assessment Tools Scales Child: 6-12 years ab: Objective: The pediatric emergency department is a highly complex and evolving environment. Despite the fact that physicians spend a majority of their time on documentation, little research has examined the role of documentation in provider workflow. The aim of this study is to examine the task of attending physician documentation workflow using a mixed-methods approach including focused ethnography, informatics, and the Systems Engineering Initiative for Patient Safety (SEIPS) model as a theoretical framework.Materials and Methods: In a 2-part study, we conducted a hierarchical task analysis of patient flow, followed by a survey of documenting ED providers. The second phase of the study included focused ethnographic observations of ED attendings which included measuring interruptions, time and motion, documentation locations, and qualitative field notes. This was followed by analysis of documentation data from the electronic medical record system.Results: Overall attending physicians reported low ratings of documentation satisfaction; satisfaction after each shift was associated with busyness and resident completion. Documentation occurred primarily in the provider workrooms, however strategies such as bedside documentation, dictation, and multitasking with residents were observed. Residents interrupted attendings more often but also completed more documentation actions in the electronic medical record.Discussion: Our findings demonstrate that complex work processes such as documentation, cannot be measured with 1 single data point or statistical analysis but rather a combination of data gathered from observations, surveys, comments, and thematic analyses.Conclusion: Utilizing a sociotechnical systems framework and a mixed-methods approach, this study provides a holistic picture of documentation workflow. This approach provides a valuable foundation not only for researchers approaching complex healthcare systems but also for hospitals who are considering implementing large health information technology projects. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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