Examining nursing vital signs documentation workflow: barriers and opportunities in general internal medicine units

Authors

  • Melanie S Yeung,

    1. Authors:Melanie S Yeung, BASc, MHSc, Clinical Engineer, Centre for Global eHealth Innovation, University Health Network, Institute of Biomaterials and Biomedical Engineering, University of Toronto; Stephen E Lapinsky, MSc, MB BCh, MD, FCPSA, FRCPC, Professor, Faculty of Medicine, University of Toronto, Mount Sinai Hospital; John T Granton, MD, FRCPC, Associate Professor, Faculty of Medicine, University of Toronto, Division of Respirology, University Health Network; Diane M Doran, PhD, RN, FCAHS, Professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto; Joseph A Cafazzo, PhD, PEng, Assistant Professor and Centre Lead, Centre for Global eHealth Innovation, University Health Network, Institute of Biomaterials and Biomedical Engineering, University of Toronto and Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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  • Stephen E Lapinsky,

    1. Authors:Melanie S Yeung, BASc, MHSc, Clinical Engineer, Centre for Global eHealth Innovation, University Health Network, Institute of Biomaterials and Biomedical Engineering, University of Toronto; Stephen E Lapinsky, MSc, MB BCh, MD, FCPSA, FRCPC, Professor, Faculty of Medicine, University of Toronto, Mount Sinai Hospital; John T Granton, MD, FRCPC, Associate Professor, Faculty of Medicine, University of Toronto, Division of Respirology, University Health Network; Diane M Doran, PhD, RN, FCAHS, Professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto; Joseph A Cafazzo, PhD, PEng, Assistant Professor and Centre Lead, Centre for Global eHealth Innovation, University Health Network, Institute of Biomaterials and Biomedical Engineering, University of Toronto and Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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  • John T Granton,

    1. Authors:Melanie S Yeung, BASc, MHSc, Clinical Engineer, Centre for Global eHealth Innovation, University Health Network, Institute of Biomaterials and Biomedical Engineering, University of Toronto; Stephen E Lapinsky, MSc, MB BCh, MD, FCPSA, FRCPC, Professor, Faculty of Medicine, University of Toronto, Mount Sinai Hospital; John T Granton, MD, FRCPC, Associate Professor, Faculty of Medicine, University of Toronto, Division of Respirology, University Health Network; Diane M Doran, PhD, RN, FCAHS, Professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto; Joseph A Cafazzo, PhD, PEng, Assistant Professor and Centre Lead, Centre for Global eHealth Innovation, University Health Network, Institute of Biomaterials and Biomedical Engineering, University of Toronto and Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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  • Diane M Doran,

    1. Authors:Melanie S Yeung, BASc, MHSc, Clinical Engineer, Centre for Global eHealth Innovation, University Health Network, Institute of Biomaterials and Biomedical Engineering, University of Toronto; Stephen E Lapinsky, MSc, MB BCh, MD, FCPSA, FRCPC, Professor, Faculty of Medicine, University of Toronto, Mount Sinai Hospital; John T Granton, MD, FRCPC, Associate Professor, Faculty of Medicine, University of Toronto, Division of Respirology, University Health Network; Diane M Doran, PhD, RN, FCAHS, Professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto; Joseph A Cafazzo, PhD, PEng, Assistant Professor and Centre Lead, Centre for Global eHealth Innovation, University Health Network, Institute of Biomaterials and Biomedical Engineering, University of Toronto and Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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  • Joseph A Cafazzo

    1. Authors:Melanie S Yeung, BASc, MHSc, Clinical Engineer, Centre for Global eHealth Innovation, University Health Network, Institute of Biomaterials and Biomedical Engineering, University of Toronto; Stephen E Lapinsky, MSc, MB BCh, MD, FCPSA, FRCPC, Professor, Faculty of Medicine, University of Toronto, Mount Sinai Hospital; John T Granton, MD, FRCPC, Associate Professor, Faculty of Medicine, University of Toronto, Division of Respirology, University Health Network; Diane M Doran, PhD, RN, FCAHS, Professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto; Joseph A Cafazzo, PhD, PEng, Assistant Professor and Centre Lead, Centre for Global eHealth Innovation, University Health Network, Institute of Biomaterials and Biomedical Engineering, University of Toronto and Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Melanie S Yeung, Clinical Engineer, Centre for Global eHealth Innovation, Toronto General Hospital, R. Fraser Elliott Building, 4th Floor, 190 Elizabeth Street, Toronto, ON, Canada M5G 2C4. Telephone: +1 416 340 4800 ext. 8423.
E-mail:melanies.yeung@utoronto.ca

Abstract

Aims.  To characterise the nursing practices of vital signs collection and documentation in a general internal medicine environment to inform strategies for improving workflow design.

Background.  Clinical workflow analysis is critical to identify barriers and opportunities in current processes. Analysis can guide the design and development of novel technological solutions to produce greater efficiencies and effectiveness in healthcare delivery. Research surrounding vital signs documentation workflow in general internal medicine environments has received very little attention making it difficult to compare the effectiveness of new technologies.

Design.  Qualitative ethnographic analyses and quantitative time–motion study were conducted.

Methods.  Workflows of 24 nurses at three hospitals in five general internal medicine environments were captured, and timeliness of vital signs assessment and documentation was measured.

Results.  Clinical assessment of vital signs was consistent, but the documentation process was highly variable within groups and between hospitals. Two themes characterised workflow barriers surrounding point-of-care documentation. First, a lack of standardised documentation methods for vital signs resulted in higher rates of transcription, increasing not only the likelihood of errors but delays in recording and accessibility of information. Second, despite advancements in electronic documentation systems, the observed system was not conducive to point-of-care documentation. Average electronic documentation was significantly longer than paper documentation. Nurses developed ad hoc workarounds that were inefficient and undermined the intent of electronic documentation.

Conclusion.  We have identified barriers and opportunities to improve the efficiency of nursing vital signs documentation. Changes in technology, workflows and environmental design allow for significant improvements and deserve further exploration.

Relevance to clinical practice.  Attention to clinical practice and environments can improve the workflow of prompt vital signs documentation and increase clinical productivity and timeliness of information for clinical decisions, as well as minimising transcription errors leading to safer patient care.

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