Revealing triage behaviour patterns in ER using a new technology for handwritten data acquisition

Article Article scientifique Article Revealing triage behaviour patterns in ER using a new technology for handwritten data acquisition eng 2009 author Despont-Gros Christelle 500861 author Cohen Gilles 71515 author Rutschmann Olivier Thierry 45545 author Geissbuhler Antoine 0000-0001-5039-3373 23387 author Lovis Christian 0000-0002-2681-8076 29016 579-587 10.1016/j.ijmedinf.2009.03.009 19423385 1386-5056 https://www.sciencedirect.com/science/article/pii/S1386505609000549 INTRODUCTION: Data acquisition is still one of the important challenges to be met in clinical settings. This is even more critic in settings with high cognitive workloads, such as emergency room (ER). Observations in these settings are difficult to realize without biases and there is little means to trace fine acquisition activities done in natural environments, using pen and papers. This study is based on the usage of a digital pen and paper (DPP) technology for the acquisition of triage information by nurses in ER. The DPP technology has been used to ease acquisition using a natural mechanism; it also minimizes the external influence of observation during acquisition activities. The aim of this study is to determine whether data recorded by the DPP technology allows explaining how ER triage nurses use the triage forms in real working conditions. METHODOLOGY: The chief physicians of the ER service wanted to have answers about three main concerns pertaining to the triage process: (1) the average time spent during the triage process; (2) the sequence in which the fields of the forms were filled and; (3) the contribution of objective measurements, such as vital signs, to the triage emergency level and decisions. In order to answer these questions, detailed log data recorded by the DPP during form filling as been analyzed and allowed to built several representations of the triage process. In addition, we completed this analysis with ethnographical-like observations. RESULTS: For seven consecutive days, 1183 triage forms have been recorded in the ER for all patients admitted. Among them, 954 forms have been digitalized and 906 forms have been considered as valid and complete. Based on this set of data, the median duration of the triage process is 143 s. There are no converging habits in filling the forms and the sequence of filling fields present a high variability. The emphasis of the objective measurements in the decisional process is rather low, as vital signs are recorded in less than 17% of the cases. CONCLUSION: The DPP technology is an original approach to study data acquisition processes in unbiased conditions. The technical raw data recorded by the DPP allows building the time series of all activities on the paper, therefore letting to constructing several representations of the process. However, the technology is not able to provide information about the context of use, for example interruptions of the form filling processes due to calls or other activities. Therefore, it is necessary to complete these analyses with qualitative approaches such as observational studies and interviews. Noticeably, as a result of this study, the head physicians of ER have redesigned the triage form to enforce the use of objective measurements and ease the data acquisition process. Biotechnology/instrumentation/methods *Computer Peripherals *Emergency Service, Hospital *Handwriting Information Storage and Retrieval/*methods *Medical Records Systems, Computerized Switzerland Triage/*methods *User-Computer Interface Dewey 576 Dewey 616.0757 136 Département de biologie structurale et bioinformatique 21E 62 Département de radiologie et informatique médicale 227 false 178 Groupe Geissbuhler Antoine (informatique médicale) 222 344 Interfaces Homme-machine en milieu clinique 610 International journal of medical informatics 78 9 baaf52d0-0ac6-437d-b073-94794cb8a379 Article (Published version) Restricted file1.pdf 494200 application/pdf restrictedAccess Faculté de médecine / Section de médecine fondamentale / Département de biologie structurale et bioinformatique Faculté de médecine / Section de médecine clinique / Département de radiologie et informatique médicale

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Revealing triage behaviour patterns in ER using a new technology for handwritten data acquisition	International journal of medical informatics	2009	840	1
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Despont-Gros, Christelle