Comparison of extent of use, information accuracy, and functions for manual and electronic patient status boards

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Abstract

Purpose

Electronic software packages to support patient tracking and disposition decision making in emergency departments (EDs) are being considered for implementation in many hospitals. We compared extent of use, information accuracy, and functions of manual and electronic patient status boards at 2 EDs where both were continuously in use.

Methods

Ethnographic observations were conducted at 2 Veterans Affairs Medical Center Emergency Departments using both manual and electronic patient status boards (100 h, 9 physicians at Site 1; 64 h, 14 physicians at Site 2). Data included board information collected at 20-min intervals, observable behavior while using boards, and interviews.

Results

Few physicians (3/9 [33%] Site 1; 0/14 [0%] Site 2) used the e-board, whereas all physicians used the whiteboards. Whiteboards had fewer inaccuracies (6/462 [1%] Site 1; 21/864 [3%] Site 2) than e-boards (62/462 [13%] Site 1; 107/864 [12%] Site 2). The primary functions of the whiteboard were to track real-time changes to patient identifiers, locations, nursing assignments, and pending activities; facilitate patient handoffs; inform physicians and nurses about newly arrived patients assigned to them; inform nurses of physicians’ orders; and inform physicians of the status of ordered items. The primary functions of the e-board were to support electronic data entry (by clerks) of patient admitting and departure times; and highlight patients who had been in the ED for longer than 6 h.

Conclusions

Whiteboards were more extensively used and had greater information accuracy than e-boards. Nevertheless, e-boards provided functionality not easily achievable with whiteboards.

Introduction

Patient status boards are a fundamental tool in most emergency departments (EDs) for tracking and communicating the real-time status of patient care activities [1], [2], [3], [4], [5], [6], [7], [8]. The traditional patient status board is a large, dry-erase board located in a central area in the ED with 1 patient per row and with columns listing handwritten information such as physician and nursing personnel assigned to patients, chief complaints, and disposition plans.

Several have proposed replacing traditional whiteboards (manual status boards) with electronic software packages (e-boards) to improve the efficiency of work and communication in the ED [9], [10]. Recently, the Veterans Health Administration (VHA) recommended installation of e-boards in all of their EDs to augment, and to potentially eventually replace, existing manual whiteboards.

The literature on introducing new technologies into complex, socio-technical systems suggests that such changes will likely have both positive and negative impacts on how work is conducted, with some changes difficult to predict in advance [11], [12], [13]. In particular, attempts to change from manual, paper-based systems to electronic systems often fail due to a loss of core functionality. A common pattern in transitions from paper to electronic login-based systems is discovering a loss in the ability for personnel from other disciplines to “listen in” or “look over the shoulders” of primary users in order to facilitate cross-disciplinary coordination [14], [15]. On the other hand, innovations are sometimes adopted for surprising reasons, supporting functions that were previously not realized to be important (e.g., use of iPods by cardiology fellows to better identify heart sounds indicative of aortic or mitral stenosis [16]).

We noted a naturally occurring experiment in which manual and e-board patient tracking systems were being used simultaneously at 2 EDs. As such, our specific research objective was to compare the extent of use, information accuracy, and functionality of each system based on direct observation and interview data. In reporting our findings, we provide insights for designing the next generation of e-boards and policy implications for e-board implementation.

Section snippets

Design

After obtaining institutional review board (IRB) approval, we conducted an observational study at EDs of 2 Veterans Affairs Medical Centers in 2008. Eighty hours of observation were planned at each site. The same 3 observers, 2 with PhDs and 1 with a master's in human factors engineering, conducted the observations at each site simultaneously to enable diversity of interpretations of the collected data.

Setting

The EDs were selected based on their parallel, continuous use of both a manual status board

Results

At Site 1, we observed 72 patient encounters during 100 h over 5 days. At Site 2, we observed a total of 45 patient encounters during 64 h over 4 days. Nine physicians, all attending physicians, were observed at Site 1 and 14 physicians, evenly split between attending and resident physicians, were observed at Site 2.

Conclusions

Using a mix of qualitative and quantitative methods, we studied the concurrent use of manual whiteboards and electronic status boards in 2 Veterans Affairs Medical Center EDs. We found that manual whiteboards were more extensively used by physicians and had greater information accuracy than electronic patient status boards. The categories of inaccurate information could lead to ‘wrong patient’ errors, patients being dropped during transitions of care, and having delays to care from confusion

Authors’ contributions

Emily S. Patterson contributed to: (1) the conception and design of the study, or acquisition of data, or analysis and interpretation of data, (2) drafting the article or revising it critically for important intellectual content, (3) final approval of the version to be submitted.

Michelle L. Rogers contributed to: (1) the conception and design of the study, or acquisition of data, or analysis and interpretation of data, (2) drafting the article or revising it critically for important

Conflict of Interest

None

Acknowledgments

This research was supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service (SHP 08-149). The views expressed in this article are those of the authors and do not necessarily represent the view of the Department of Veterans Affairs. The study sponsor had no involvement in the study design, in the collection, analysis and interpretation of data; in the writing of the manuscript; or in the decision to submit the manuscript for

References (20)

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