Computerized prescriber order entry implementation in a physician assistant-managed hematology and oncology inpatient service: effects on workflow and task switching.

PURPOSE: Little is known about the impact of computerized prescriber order entry (CPOE) systems on inpatient hematology/oncology services. The objective of this study was to quantify the impact of an inpatient CPOE implementation on workflow, with an emphasis on ordering and direct patient care time. METHODS: We conducted a direct-observation time-and-motion study of the provider team of a hematology/oncology inpatient service both before and after CPOE implementation, characterizing workflow into 60 distinct activity categories. The provider team comprised physician assistants supervised by attending physicians. Results were adjusted to account for variations in the census. We also conducted an analysis of computer logs to assess CPOE system usage. RESULTS: Study participants were observed for 228.0 hours over 53 observation sessions. There was little change in the proportion of census-adjusted time spent on ordering (10.2% before v 11.4% after) and on direct patient care (50.7% before v 47.8% after). Workflow fragmentation decreased, with providers spending an average of 131.2 seconds on a continuous task before implementation and 218.3 seconds after (P < .01). An eight-fold decrease in the number of pages was observed during the course of the study. CONCLUSION: CPOE implementation did not negatively affect time available for direct patient care. Workflow fragmentation decreased, which is likely beneficial.

Measurement of foot traffic in the operating room: implications for infection control.

Surgical site infections cause significant morbidity and mortality in the postoperative period. Opening of the operating room door disrupts its filtered atmosphere, increasing contamination above the wound. We conducted a study of traffic in the operating room as a risk for infections. This is an observational study of recorded behaviors in the operating room. Data collected included number of people entering/exiting, the role of these individuals, and the cause for the event. A total of 3071 door openings were recorded in 28 cases. Traffic varied from 19 to 50 events per hour across specialties. The preincision period represented 30% to 50% of all events. Information requests accounted for the majority of events. Door openings increase in direct proportion to case length, but have an exponential relationship with the number of persons in the operating room. There is a high rate of traffic across all specialties, compromising the sterile environment of the operating room.