A ward-based time study of paper and electronic documentation for recording vital sign observations

Objective: To investigate time differences in recording observations and an Early Warning Score (EWS) using a traditional paper chart and a novel e-Obs system, in clinical practice. Methods: Researchers observed the process of recording observations and EWS across three wards in two university teaching hospitals immediately before and after the introduction of the e-Obs system. The process of recording observations included both measurement and documentation of vital signs. Interruptions were timed and subtracted from the measured process duration. Multilevel modelling was used to compensate for potential confounding factors. Results: 577 nurse events were observed (281 Paper, 296 e-Obs). The geometric mean time to take a complete set of vital signs was 215s (95% CI: 177s-262s) on paper, and 150s (95% CI: 130s-172s) electronically. The treatment effect ratio was 0.70 (95% CI: 0.57-0.85, p<0.001). The treatment effect ratio in ward 1 was 0.37 (95% CI: 0.26-0.53), in ward 2 was 0.98 (95% CI: 0.70-1.38), and in ward 3 was 0.93 (95% CI: 0.66-1.33). The treatment effect ratios on wards 2 (p=0.91) and 3 (p=0.70) were not significant. Discussion: Introduction of an e-Obs system was associated with a statistically significant reduction in overall time to measure and document vital signs electronically, in comparison to paper documentation. The reductions in time varied between wards and were of clinical significance on only one of three wards studied. Conclusion: Our results suggest that the introduction of an e-Obs system may lower nursing workload in addition to increasing documentation quality.