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The impact of an electronic patient bedside observation and handover system on clinical practice: mixed-methods evaluation

Lang, Alexandra; Simmonds, Mark; Pinchin, James; Sharples, Sarah; Dunn, Lorrayne; Clarke, Susan; Bennett, Owen; Wood, Sally; Swinscoe, Caron

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Mark Simmonds

Professor of Human Factors

Lorrayne Dunn

Susan Clarke

Owen Bennett

Sally Wood

Caron Swinscoe


Background: Patient safety literature has long reported the need for early recognition of deteriorating patients. Early warning scores (EWSs) are commonly implemented as “track and trigger,” or rapid response systems for monitoring and early recognition of acute patient deterioration. This study presents a human factors evaluation of a hospital-wide transformation in practice, engendered by the deployment of an innovative electronic observations (eObs) and handover system. This technology enables real-time information processing at the patient’s bedside, improves visibility of patient data, and streamlines communication within clinical teams.

Objective: The aim of this study was to identify improvement and deterioration in workplace efficiency and quality of care resulting from the large-scale imposition of new technology.

Methods: A total of 85 hours of direct structured observations of clinical staff were carried out before and after deployment. We conducted 40 interviews with a range of clinicians. A longitudinal analysis of critical care audit and electronically recorded patient safety incident reports was conducted. The study was undertaken in a large secondary-care facility in the United Kingdom.

Results: Roll-out of eObs was associated with approximately 10% reduction in total unplanned admissions to critical care units from eObs-equipped wards. Over time, staff appropriated the technology as a tool for communication, workload management, and improving awareness of team capacity. A negative factor was perceived as lack of engagement with the system by senior clinicians. Doctors spent less time in the office (68.7% to 25.6%). More time was spent at the nurses’ station (6.6% to 41.7%). Patient contact time was more than doubled (2.9% to 7.3%).

Conclusions: Since deployment, clinicians have more time for patient care because of reduced time spent inputting and accessing data. The formation of a specialist clinical team to lead the roll-out was universally lauded as the reason for success. Staff valued the technology as a tool for managing workload and identified improved situational awareness as a key benefit. For future technology deployments, the staff requested more training preroll-out, in addition to engagement and support from senior clinicians.

Journal Article Type Article
Acceptance Date Nov 22, 2018
Online Publication Date Mar 6, 2019
Publication Date Mar 6, 2019
Deposit Date Apr 9, 2019
Publicly Available Date Apr 9, 2019
Journal JMIR Medical Informatics
Electronic ISSN 2291-9694
Publisher JMIR Publications
Peer Reviewed Peer Reviewed
Volume 7
Issue 1
Article Number e11678
Keywords health information technology; early warning score; mobile health; staff workload; clinical deterioration; patient safety; mixed methods
Public URL
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The Impact of an Electronic Patient Bedside Observation and Handover System on Clinical Practice: Mixed-Methods Evaluation (799 Kb)

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