Impact of a Clinical Information System on Multitasking in Two Intensive Care Units

Health Care Providers (HCPs) in Intensive Care Units (ICUs) communicate effectively to coordinate timely patient care. HCPs rapidly switch between patient care, documentation and communication tasks such that they are completed simultaneously or nearly simultaneously, a phenomenon termed multitasking. An electronic charting tool or Critical Care clinical Information System (CCIS) may facilitate information sharing, but system related changes in multitasking have not been investigated. Trained observers followed physicians, nurses, respiratory therapists, and unit clerks in two ICUs and recorded their tasks. Observations were completed before the introduction of the CCIS at 3 and at 12 months afterward, using the Work Observation Method By Activity Timing (WOMBAT). Amounts of time HCPs spent performing multitasking before and after the CCIS introduction were compared, along with the tasks composing multitasking events. Before the CCIS introduction, respiratory therapists, nurses, and physicians spent approximately 30-40% of their time multitasking, whereas unit clerks spent less time multitasking (14%-18%). Percentages of time spent multitasking decreased to values between 10% and 25%. Documentation and communication tasks accounted for large proportions of the multitasking reduction. Cognitive burdens associated with learning new documentation methods, or constraints of charting at bedside terminals may be causes of observed reductions in multitasking. Perceptions of poorer communication, lower productivity, and less staff acceptance of the CCIS may result.