The varying impact of two clinical information systems in a cardiovascular intensive care unit

• HIT Description: Hospital information system for order entry, results retrieve, and administration recording, and a bedside documentation system More info...
  
• Purpose of Study: Compare the impact of two clinical information systems in an intensive care unit
  
• Years of study: 1995-1996
  
• Study Design: Pre-post
  
• Outcomes: Nursing activity patterns, staff satisfaction, and costs
  

• Settings: The cardiovascular intensive care unit at the University of Alabama at Birmingham Hospital, a 20-bed unit and received adult and pediatric patients after cardiovascular and thoracic surgeries of all types.
• Intervention: Implemented two different clinical information systems within one year
• Evaluation Method: Work sampling study, self-administered staff surveys
• Description: System 1: Hospital information system (HIS) for ordering diagnostics procedures and retrieving the results, ordering medication and IV fluid, and administration recording. System 2: CareVue 9000, a bedside documentation system allowed chart data to be abstracted automatically for research and quality improvement purposes.
• Extrinsic Factors in valuing cost and benefits: The study unit has a staff of between 65 and 70 full time employees. The medican length of stay is under 24 hours. In fiscal year 1997, 4097 patient days of care were delivered. Prior to 1996, nurses used paper flowsheets, medication administration records, and progress notes.
• Cost of HIT systems: : Installation of the CareVue9000 system involved capital costs of $604,423 (year of cost not specified) and a $12,000 annual contract for maintenance and software support. Annual opportunity cost of capital (@5% over 5 years) was $132,865.
• Cost of Implementation: The CareVue9000 had a cost of $387 for printing patient records annually. Training costs were about $9,000.� � ¤ The full annual costs were approximately $145,253, plus one time training cost.� � ¤ Annual implementation costs for the use of the HIS for medication charting were nearly zero because it is already in place.
• Changes in efficiency and productivity: Staff was more satisfied with CareVue 9000 than the other system. Overall nursing time spent on charting did not change after the two systems were introduced. When only the CareVue 9000 system was considered, the result was a 67-minute savings per shift (equivalent to 2.6 FTEs), which translated into $114,000 per year saved (not stated as to year of cost). Consequently, the other system costed $114,000 due to the annual burden in nursing time.� � o Replacement of an old data management system saved, annually, an estimate of $38,500 in operating costs and $54,500 of the old system failure cost. Additionally, there was estimated savings of $100,000 in disposable supplies, $156,000 from autotransfusion of banked donor blood, and $2,612 for cost of flowsheets. The $351,612 savings from prior system plus the savings in nursing time made an estimate of net annual savings in the amount of $320,359 from CareVue 9000.�