Validation of the Work Observation Method By Activity Timing (WOMBAT) method of conducting time-motion observations in critical care settings: an observational study

Abstract

BackgroundElectronic documentation handling may facilitate information flows in health care settings to support better coordination of care among Health Care Providers (HCPs), but evidence is limited. Methods that accurately depict changes to the workflows of HCPs are needed to assess whether the introduction of a Critical Care clinical Information System (CCIS) to two Intensive Care Units (ICUs) represents a positive step for patient care. To evaluate a previously described method of quantifying amounts of time spent and interruptions encountered by HCPs working in two ICUs.MethodsObservers used PDAs running the Work Observation Method By Activity Timing (WOMBAT) software to record the tasks performed by HCPs in advance of the introduction of a Critical Care clinical Information System (CCIS) to quantify amounts of time spent on tasks and interruptions encountered by HCPs in ICUs.ResultsWe report the percentages of time spent on each task category, and the rates of interruptions observed for physicians, nurses, respiratory therapists, and unit clerks. Compared with previously published data from Australian hospital wards, interdisciplinary information sharing and communication in ICUs explain higher proportions of time spent on professional communication and documentation by nurses and physicians, as well as more frequent interruptions which are often followed by professional communication tasks.ConclusionsCritical care workloads include requirements for timely information sharing and communication and explain the differences we observed between the two datasets. The data presented here further validate the WOMBAT method, and support plans to compare workflows before and after the introduction of electronic documentation methods in ICUs.

Characteristics of distractions in the intensive care unit: how serious are they and who are at risk?

“…Prior studies were found to have yielded comparable frequencies of distractions, (1,5) validating our simple observational method. For instance, Ballermann et al found a mean interruption rate of 3.8 times per hour among ICU physicians.…”

“…For instance, Ballermann et al found a mean interruption rate of 3.8 times per hour among ICU physicians. (5) A more recent study reported a frequency of 6.5 times per hour, although this finding was based on data from only three ICU shifts.…”

“…Baseline data are crucial to direct and assess the effects of quality improvement interventions. Apart from the frequency of distractions, (1,5) knowledge of the nature of distractions, their impact on the original activity and the risk factors for these distractions would also be relevant. However, in general, we found that certain studies had omitted distractions that did not lead to interruptions.…”

“…However, in general, we found that certain studies had omitted distractions that did not lead to interruptions. (5) The tools used to study distractions have ranged from simple forms to complex instruments using proprietary software. (5)(6)(7) Simple forms are likely to be more useful for individual ICUs to audit their own interventions.…”

“…(5) The tools used to study distractions have ranged from simple forms to complex instruments using proprietary software. (5)(6)(7) Simple forms are likely to be more useful for individual ICUs to audit their own interventions. Thus, in the present study, we used a simple observational method to describe the frequency, sources and severity of distractions, and delineate at-risk situations in our ICU.…”