Review: Mobile and Fixed Computer Use by Doctors and Nurses on Hospital Wards

The paper reviewed here is ‘Mobile and Fixed Computer Use by Doctors and Nurses on Hospital Wards: Multi-method Study on the Relationships Between Clinician Role, Clinical Task, and Device Choice’ by Andersen and colleagues and freely available here. In the abstract the authors draw a number of conclusions including the following

‘Nurses’ work, and clinical tasks performed by doctors during ward rounds, require highly mobile computer devices‘

as well as

‘In selecting hardware devices, consideration should be given to who will be using the devices, the nature of their work and the physical layout of the ward‘

The researchers aims were stated as answering the following

‘(1) which device is used by whom, where, for which clinical task, and in collaboration with whom? and (2) what impact does the design of the device have on its use on hospital wards?‘

The researchers used a complex design for the study which involved direct observation of staff during task completion as well as questionnaires and assessment of the hardware devices (assessed with the usability criteria listed here).  The study was set in 2 geriatric wards in Sydney. It could be argued that these results are generalisable but also that the study’s findings are restricted to this particular type of service (i.e Australian geriatric wards). In favour of the latter, in some services configurations ward rounds may be conducted in one place in which case stationary computers would have benefits over mobile devices with the former typically having more resources per unit cost. Devices included desktop PC’s and devices on wheels as well as tablet PC’s.

The study was conducted over an 18-day period and included doctors and nurses with an average of just under 3-years experience on the study ward. It would have been interesting to see the results if staff had been stratified according to the number of years experience on the ward and it would have been particularly interesting to see the results in those with the most experience (although experience may influence the roles). The observational data collection took place between 7am and 4pm. A number of details were recorded in the study and the clinical tasks documented are listed in Table 1. The authors also include a schematic diagram of the wards illustrating the placement of some of the computers.

Given the nature and amount of data that was collected, there are numerous results in both quantitative and qualitative formats. In terms of the observed tasks, I found the following particularly interesting

‘The most frequently observed tasks were administering drugs (31.4%), preparing drugs (27.9%), and reviewing a patient’s chart (15.4%)‘

Nurses were predominantly using computers-on-wheels for their tasks particularly in conjunction with medication administration. Just under 40% of the doctors were using tablet PC’s – mainly to ‘review charts and view results’. Furthermore the doctors weren’t using the tablet PC’s when not on the ward round. In the questionnaires, several of the staff said they had not received training in using devices such as the tablet PC’s. This raises the important issue of how much these results are dependent on the training staff receive and how much training would have influenced the results reported here.

The researchers have been creative in the design of this study, trying to encapsulate the use of mobile and desktop computers in a hospital ward using a combination of quantitative and qualitative methodology. The study highlights some of the important factors that determine the success of such technology. These factors include the functions of the service, the types of devices, the functions for which those devices are being used, the software that is being used for those devices (although the operating system was specified, the individual software programs were not discussed in detail) and the training for both the software and the devices.

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