[Perception and use of an electronic medical record system by professionals of a public psychiatric hospital]. / Perception et utilisation d'un dossier patient informatisé par les professionnels d'un établissement public de psychiatrie.

OBJECTIVES: The aim of this study was to evaluate the interest taken by the health care providers in the electronic medical file and its use within the quality improvement process. SETTING: Our institution is a 204-bed psychiatric hospital, employing 328 professionals and comprising three sectors: six units of complete hospitalisation (102 beds), one unit of week hospitalisation (15 beds), one unit of emergency (7 beds) and one unit of night hospitalisation (15 beds). Three extrahospital structures include the day hospitalisation (65 places), the medicopsychological centers (CMP) and the part-time therapeutic reception centers (CATTP) of the three sectors. METHODS: We conducted face-to-face, semi-structured interviews with health care providers of a public psychiatric hospital. All the solicited people agreed to answer the investigation. The interviews were conducted until no new ideas emerged in the content analysis performed in real time, comprising 60 care providers: 10 psychiatrists, 42 nurses and eight paramedical professionals. Content analysis was performed by two members of the steering committee who were skilled in textual analysis. A descriptive analysis was also performed. The variables were described by proportions and means. The proportions were compared using the Chi-squared test or Fisher exact test where appropriate. A two-tailed P-value of greater than 0.05 was considered to indicate statistical significance. Statistical analyses were carried out using SPSS version 13.0. RESULTS: Ninety-six percent of the interviewed subjects used the electronic medical file. The average number of daily use was seven (S.D.=5). Sixty-seven percent had a favorable opinion of the electronic medical file. Physicians had more frequent favorable opinions than nurses who considered that electronic medical files cannot capture real nursing activity. Health care providers considered that electronic medical file could be associated with improved quality of care, but two points should be taken into account: the increased documentation time (slow system response, multiple screens, the lack of computer knowledge, the absence of bedside documentation technology...) and dysfunctions in the information processing system. This could have an impact on documentation completeness, and quality and could also lead to a reduction of time devoted to care. CONCLUSION: This study proposes tracks of improvement in the use of the DPIP. In spite of this, a true debate must be initiated on these new information systems in psychiatry since their real objectives can be perceived as ambiguous, so that programs of clarification, education and reinsurance can be set-up.

Assessment of psychiatric inpatient satisfaction: a systematic review of self-reported instruments.

BACKGROUND: There is a growing concern about satisfaction with inpatient psychiatric services. There are currently numerous satisfaction instruments available to psychiatric inpatients, but little guidance on which among them to select. AIMS: To provide an overview of the psychometric properties and the content of satisfaction instruments available to psychiatric inpatients. METHODS: Systematic searches of Medline database to identify inpatient satisfaction questionnaires. Assessment of the instruments according to relevant psychometric properties. RESULTS: Fifteen satisfaction instruments were identified. The target population differed according to the instrument. Methods used to generate items were heterogeneous. These instruments were based on a mixed approach including patients' points of view, expert opinions, and literature reviews, causing the content of questionnaires to vary. Reliability and validity were not systematically tested. CONCLUSION: The validation of a common inpatient satisfaction instrument is a major challenge. Recommendations for the future development of satisfaction instruments may include: item generation based exclusively on the patient's point of view; a validation process on a large and representative population; and an instrument combining generic (core questionnaire) and specific (additional modules) approaches.