Now which device would you use where, for what and when. A tablet PC in the ward, a tablet PC, a computer on wheels (COW) or an ergonomic computer on wheels (COW)?
The doctors made the following choices:
On ward rounds, the majority of tasks (57.3%) were completed using a generic COW, while 35.9% were completed using a tablet PC. These two devices were most frequently used in the corridor, followed by the patients’ rooms, to review charts and view results. Use of a tablet PC at the workstation was observed more often than the use of a stationary PC (Table 3). Of the 234 clinical tasks completed during ward rounds, 57.3% were undertaken in the corridors, 29.1% in the patients’ rooms, and 3% at a patient’s bedside.
When not on the ward they mostly used a stationary PC. They did not use a tablet PCs or the ergonomic COW when not on ward rounds. They used the stationary PCs to view results and review charts, and generate discharge summaries, most often within the doctors’ office.
The generic COWs were preferred because of the space on the trolley and storage space. Another important factor was the size of the large screen, allowing more persons to view the screen. They preferred the tablet PC if they weighed less and had a handle which made it easy to transport.
The ergonomic COWs were not preferred because the available table space in front of the screen was limited. Also, the ergonomic COW had a 14″ screen, whereas the generic COWs had a 17″ screen. The ergonomic COW was also reported as being “hard to push around”.
The preferences for nurses did not differ from those of the doctors.
Why is this important?
Because the results provide some key information which may assist health planners in hospitals to plan and evaluate their computer hardware device needs. COW’s should be able to store sufficient paper charts and medications and they should be easy to handle with a large screen. COWs are mostly used during ward rounds. Tablet PCs were hardly used mostly due to lack of training in using them. The computers were mostly used in the corridors so there is no need for PC at each patient’s bedside
How was this study done?
Twenty-seven nurses and eight doctors were observed for a total of 80 hours as they used a range of computing devices to access a computerized provider order entry system on two wards at a major Sydney teaching hospital. Observers used a checklist to record the clinical tasks completed, devices used, and location of the activities. Field notes were also documented during observations. Semi-structured interviews were conducted after observation sessions
Andersen P, Lindgaard AM, Prgomet M, Creswick N, & Westbrook JI (2009). Mobile and fixed computer use by doctors and nurses on hospital wards: multi-method study on the relationships between clinician role, clinical task, and device choice. Journal of medical Internet research, 11 (3) PMID: 19674959
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Isn’t the one bottom-left “the machine that goes Piiinnng!”?
That’s it. I knew it from somewhere…….
Computer Use by Doctors….very useful info… thanks
Thanks for sharing. Is there an audit trail as paper notes are more difficult to change (unless you remove whole sheets or burn files)
The Cockroach Catcher
Fascinating – did you gather any information on handheld devices? Do you suspect the “in patient room” or “at patient bedside” response rates look different if you had included those? It’s of interest because we make iPhone apps for use while on rounds (U.S.).
Germs generally live a lot longer on plastic surfaces than on paper.
The computer may well be the new doorknob as far as contaminated surfaces go. I notice that neither of the example computer on wheels (COW) units had a hand washing or sanitizing station bolted on. Hmmm…
Good point, let’s hope this picture was just taken for the publication before use. Kind regards Dr Shock
Very usefull article. I like the user-centric and the down-to-earth approach. I referred to it yesterday in a meeting about hardware selection criteria.
This was really good, thanks.