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The Effect of Computer-generated Reminders on Charting Deficiencies in the ICU

Affiliations of the authors: Oracle Corporation, Redwood Shores, California (TAO); LDS Hospital Department of Critical Care and University of Utah Departments of Internal Medicine and Medical Informatics, Salt Lake City, Utah (TPC); University of Utah Department of Medical Informatics (emeritus), Salt Lake City, Utah (TAP).

Correspondence and reprints: Tom Oniki, PhD, 9740 Dynasty Way, Elk Grove, CA 95624; e-mail: <tom.oniki{at}oracle.com>.

Objective: To examine the effect of computer-generated reminders on nurse charting deficiencies in two intensive care units.

Design: Nurses caring for a group of 60 study patients received patient-specific paper reminder reports when charting deficiencies were found at mid-day. Nurses caring for a group of 60 control patients received no reminders. A group of 60 retrospective patients was also formed.

Measurements: The average numbers of charting deficiencies at the end of the shift in each of the three groups were compared using two planned orthogonal contrasts.

Results: The average in the study group patients was 1.02 deficiencies per day per patient, whereas the control group the average was 1.40 deficiencies per day per patient (p = 0.001). The average number of end-of-shift deficiencies in the pooled prospective (study/control) population was 1.21 deficiencies per day per patient, compared with the average in the retrospective group of 1.56 deficiencies per day per patient (p < 0.001).

Conclusion: The decrease was likely due both to the appropriate response of the nurses to the reminders and to a learned attentiveness to the tasks on the part of the nurses who cared for study patients. Greater gains were hindered by incomplete "coupling" of the reminders to the end-of-shift deficiencies and by inaccuracies in the reminders.

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