Administrative Workload in the Intensive Care Unit (AWIC)

Administrative Workload in the Intensive Care Unit (AWIC Study)

A prospective observational study in the Intensive Care Unit and the Medium Care Unit in a university hospital in Amsterdam. Recent studies show that administrative tasks occupy more than 30% of the workload. One-third of these administrative tasks is unrelated to care. The administrative workload of physicians and nurses will be observed and quantified using two different methods. The amount of time physicians and nurses are logged on into the patient data management system (PDMS) will be measured and the time spent on different work tasks will be monitored with a work sampling method. Two different patient data management systems will be compared.

Study Overview

• Status: Unknown
• Conditions: Critical Illness

Detailed Description

In recent years, regulatory authorities request a growing number of protocols and checklists to improve healthcare. Though the intention is to prevent medical mistakes and to improve patient care, these demands might result in an increased administrative workload for physicians and nurses. Recent studies show that administrative tasks and documentation occupy more than thirty percent of the workload of physicians, of which one-third is unrelated to care. This time spent on administration could lower the amount of time spent with the patient and the patient's family. In the Intensive Care Unit and the Medium Care Unit, most of the administrative tasks are executed within the patient data management system. The way an electronic patient data management system is set up could impact the administrative workload for physicians and nurses. A prospective observational study at the department of Intensive and Medium Care of the University medical centre will be performed with the aim to quantify the time spent on direct patient care versus administrative work. Two different patient data management systems will be compared at different points in time. The Nursing Activity Score and other patient characteristics will be registered for all the admitted patients during the two study periods.

The administrative workload of physicians and nurses will be measured before and after the implementation of a new patient data management system, using the following methods:

• Login time in the electronic patient data management system during fourteen consecutive days in the Intensive Care Unit and the Medium Care Unit
• Timing of activities of physicians and nurses with a work sampling method during five consecutive day shifts in the Intensive Care Unit

• Study Type: Observational
• Enrollment (Anticipated): 200

Contacts and Locations

Study Locations

• Netherlands
  • Noord-Holland
    • Amsterdam, Noord-Holland, Netherlands, 1007 MB
      • Recruiting
      • VUMedicalCentre
      • Contact: Jantine G Rottgering, Bsc; Phone Number: 0204443331; Email: j.rottgering@vumc.nl
      • Contact: Angelique ME Spoelstra - de Man, PhD Md; Phone Number: 0204443331; Email: am.spoelstra@vumc.nl

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

All patients admitted to the Intensive Care Unit during one of the two study periods

Description

Inclusion Criteria:

• Admission to the Intensive Care Unit during one of the two study periods

Exclusion Criteria:

• Not applicable

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
Patients admitted during measurement 1; All patients admitted to the Intensive Care and Medium Care Unit during a two-week study period before the implementation of a new electronic patient data management system
Patients admitted during measurement 2; All patients admitted to the Intensive Care and Medium Care Unit during a two-week study period after the implementation of a new electronic patient data management system

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Login time in the PDMS per hour for nurses	The amount of time being logged on to the PDMS per hour will be calculated for different shifts	24 hours a day
Login time in the PDMS per hour for doctors	The amount of time being logged on to the PDMS per hour will be calculated for different shifts	24 hours a day
Amount of time spent on administrative work and documentation per shift for nurses	The amount of time spent on administrative tasks and documentation during dayshifts measured with a work sampling methode	9 hours a day
Amount of time spent on administrative work and documentation per shift for doctors	The amount of time spent on administrative tasks and documentation during dayshifts measured with a work sampling methode	9 hours a day

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Amount of time spent on direct patient care per shift for nurses	The amount of time spent on direct care during dayshifts measured with a work sampling methode	9 hours a day
Amount of time spent on direct patient care per shift for doctors	The amount of time spent on direct care during dayshifts measured with a work sampling methode	9 hours a day

Collaborators and Investigators

• Sponsor: Amsterdam UMC, location VUmc
• Investigators: Study Director: Angelique ME Spoelstra - de Man, MD PhD, Amsterdam UMC, location VUmc

Publications and helpful links

General Publications

• Li L, Hains I, Hordern T, Milliss D, Raper R, Westbrook J. What do ICU doctors do? A multisite time and motion study of the clinical work patterns of registrars. Crit Care Resusc. 2015 Sep;17(3):159-66.
• Armstrong E, de Waard MC, de Grooth HJ, Heymans MW, Reis Miranda D, Girbes AR, Spijkstra JJ. Using Nursing Activities Score to Assess Nursing Workload on a Medium Care Unit. Anesth Analg. 2015 Nov;121(5):1274-80. doi: 10.1213/ANE.0000000000000968.
• Bosman RJ. Impact of computerized information systems on workload in operating room and intensive care unit. Best Pract Res Clin Anaesthesiol. 2009 Mar;23(1):15-26. doi: 10.1016/j.bpa.2008.10.001.
• Urden LD, Roode JI. Work sampling. A decision-making tool for determining resources and work redesign. J Nurs Adm. 1997 Sep;27(9):34-41. doi: 10.1097/00005110-199709000-00009.
• Pelletier D, Duffield C. Work sampling: valuable methodology to define nursing practice patterns. Nurs Health Sci. 2003 Mar;5(1):31-8. doi: 10.1046/j.1442-2018.2003.00132.x.
• Marasovic C, Kenney C, Elliott D, Sindhusake D. A comparison of nursing activities associated with manual and automated documentation in an Australian intensive care unit. Comput Nurs. 1997 Jul-Aug;15(4):205-11.

Study record dates

Study Major Dates

• Study Start: January 1, 2016
• Primary Completion (Actual): May 1, 2017
• Study Completion (Anticipated): January 1, 2020

Study Registration Dates

• First Submitted: March 31, 2016
• First Submitted That Met QC Criteria: March 31, 2016
• First Posted (Estimate): April 6, 2016

Study Record Updates

• Last Update Posted (Actual): April 26, 2019
• Last Update Submitted That Met QC Criteria: April 25, 2019
• Last Verified: April 1, 2019

More Information

Terms related to this study

• Keywords: Intensive Care Unit; Administrative workload; Patient data management system; Work sampling method; Nursing Activity Score
• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Critical Illness
• Other Study ID Numbers: 2015.564

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO