Papers by Nerida Creswick
To cite this article: Creswick, Nerida and Callen, Joanne. What Do Doctors, Senior Managers and I... more To cite this article: Creswick, Nerida and Callen, Joanne. What Do Doctors, Senior Managers and IT Professionals Perceive to Be the Key Factors in the Use of Clinical Information Systems? [online]. In: Webb, Robert (Editor); Ribbons, Robert M; Dall, Veronica. HIC ...
PubMed, 2012
The Intensive Care Unit (ICU) is an information intense environment where Clinical Information Sy... more The Intensive Care Unit (ICU) is an information intense environment where Clinical Information Systems (CISs) can greatly impact patient care and the workload of clinicians. With the introduction of an ICU CIS imminent across New South Wales hospitals, we aimed to understand how ICU clinicians perceived a new system would impact on work practices in Australian ICUs, as much of the current evidence is generated from overseas. We conducted interviews with 66 doctors and nurses in 3 ICUs without a CIS. Many had positive perceptions regarding the impact of its introduction, though others were more guarded and unsure. Clinicians believed information access to patient would improve, communication processes could potentially change and there was potential for work processes to be more efficient. It was expected that ward rounds and handover would be less disrupted with all information available at the bedside or at the handover setting. There were mixed responses about whether a CIS would save time and how it would influence patient care, though the majority believed a CIS would improve safety by providing a means for increasing accountability and reducing medication errors. Concerns were raised about the transition from paper to a CIS and the training required. This information provides valuable evidence in the Australian setting regarding clinicians' expectations of a new ICU CIS to assist with future implementations. It also provides baseline data as a foundation for future research once the CIS is implemented. It is clear that robust quantitative studies are required to gain a detailed understanding of how a new CIS will impact clinicians' work processes and that appropriate training is crucial for full benefits to be achieved.
Topic area and paper objectives: This study aimed to explore whether information and communicatio... more Topic area and paper objectives: This study aimed to explore whether information and communication technology (ICT) improved information access for emergency department (ED) nurses and what impact nurses perceived this had on how they carried out their work. This research is part of a larger multi-site project which aims to explore work innovations resulting from the use of ICT in hospitals, in particular how technology can improve clinicians' work and outcomes for patients. Background: ED clinicians are required to ...
Electronic Journal of Health Informatics, Jul 19, 2011
It is essential for emergency department (ED) nurses to efficiently access and record patient inf... more It is essential for emergency department (ED) nurses to efficiently access and record patient information in order to provide treatment to patients, communicate with other health professionals and manage patient flow. Electronic clinical information systems can facilitate improved information access, however few studies have examined whether this potential is being realised, particularly by nurses. This study aimed to explore whether information and communication technology (ICT) improved information access for ED nurses and the impact nurses perceived this had on how they carried out their work. Within a socio-technical framework, a qualitative study design was employed using semistructured interviews (n=4) and a focus group (n=7) at one Australian metropolitan public hospital ED. The results presented relate to nurses' perceptions of the impact of the technology on one of the themes elicited from the data, namely 'access to information'. Nurses reported that the integrated ED clinical information system made it easier for them to access information, such as test results and previous electronic discharge summaries which had positive effects on patient care and on their roles. This study highlighted the value of technology in facilitating increased volume and improved ease of access to clinical, patient flow-related, knowledge-based and administrative information supporting ED nurses in practicing evidence-based nursing. It reduces the need for unnecessary interruptions of other clinical staff and allows nurses to take on extended roles in patient management.
PubMed, 2012
An important step in advancing global health through informatics is to understand how systems sup... more An important step in advancing global health through informatics is to understand how systems support health professionals to deliver improved services to patients. Studies in several countries have highlighted the potential for clinical information systems to change patterns of work and communication, and in particular have raised concerns that they reduce nurses' time in direct care. However measuring the effects of systems on work is challenging and comparisons across studies have been hindered by a lack of standardised definitions and measurement tools. This paper describes the Work Observation Method by Activity Time (WOMBAT) technique version 1.0 and the ways in which the data generated can describe different aspects of health professionals' work. In 2011 a revised WOMBAT version 2.0 was developed specifically to facilitate its use by research teams in different countries. The new features provide opportunities for international comparative studies of nurses' work to be conducted.
PubMed, 2007
Electronic medication systems may impact communication in hospital wards. To identify the ways in... more Electronic medication systems may impact communication in hospital wards. To identify the ways in which communication patterns may be altered it is necessary to compare processes both before and after system introduction. This paper reports the use of a social network approach to examine the medication advice-seeking network of an Australian hospital renal ward before the introduction of an electronic medication management system. A social network questionnaire was completed by 96% of staff members (doctors, nurses, allied health professionals and administrative staff) on the ward (n=45). Survey data were analysed to produce a sociogram to display the medication advice-seeking network of the staff in the ward. The results showed that there was a relatively low level of advice-seeking about medication-related decisions and tasks. Most communication occurred within professional groups. Several key individuals were pivotal in providing advice both within and across professional groups.
BMC Health Services Research, Sep 15, 2009
Background: Communities of practice and social-professional networks are generally considered to ... more Background: Communities of practice and social-professional networks are generally considered to enhance workplace experience and enable organizational success. However, despite the remarkable growth in interest in the role of collaborating structures in a range of industries, there is a paucity of empirical research to support this view. Nor is there a convincing model for their systematic evaluation, despite the significant potential benefits in answering the core question: how well do groups of professionals work together and how could they be organised to work together more effectively? This research project will produce a rigorous evaluation methodology and deliver supporting tools for the benefit of researchers, policymakers, practitioners and consumers within the health system and other sectors. Given the prevalence and importance of communities of practice and social networks, and the extent of investments in them, this project represents a scientific innovation of national and international significance. Methods and design: Working in four conceptual phases the project will employ a combination of qualitative and quantitative methods to develop, design, field-test, refine and finalise an evaluation framework. Once available the framework will be used to evaluate simulated, and then later
International Journal of Medical Informatics, 2009
To identify the main concerns of a broad range of hospital staff about the implementation of a ne... more To identify the main concerns of a broad range of hospital staff about the implementation of a new Computerized Provider Order Entry (CPOE) system for medication management. Methods: The study was conducted in a large Australian teaching hospital using semistructured interviews (n = 20) and focus groups (six focus groups involving a total of 30 participants) from a broad section of health professionals including doctors, nurses, managers, pharmacists and senior health executives. Systematic concurrent analysis of the data was undertaken by a team of researchers. Results: We identified 20 recurrent themes related to nine areas of shared concern including work practices, software/hardware, relationships/communication, education and training, inexperienced staff and de-skilling. A higher level of analysis identified four interrelated constructs that highlight what people are concerned about: (1) Will it help? (2) Will it work? (3) Will we cope? (4) Will it impair existing interaction? Limitations: The research provides a snapshot overview of perceptions from a range of hospital personnel in the lead up to CPOE implementation. Generalizability is limited by the size of the sample and the contextual circumstances of the hospital being studied. Discussion: This work contributes valuable evidence about an often-neglected dimension in the evaluation of computer systems in hospitals, namely the pre-implementation concerns of staff. These pre-conceptions can have a significant effect on how technology is implemented and utilised. Acknowledging and addressing people's concerns can contribute to the establishment of durable channels of negotiation and communication. Further research informed by the findings of this study will help advance this process.
BMC Health Services Research, Nov 8, 2009
Background: Widespread adoption of information and communication technologies (ICT) is a key stra... more Background: Widespread adoption of information and communication technologies (ICT) is a key strategy to meet the challenges facing health systems internationally of increasing demands, rising costs, limited resources and workforce shortages. Despite the rapid increase in ICT investment, uptake and acceptance has been slow and the benefits fewer than expected. Absent from the research literature has been a multi-site investigation of how ICT can support and drive innovative work practice. This Australian-based project will assess the factors that allow health service organisations to harness ICT, and the extent to which such systems drive the creation of new sustainable models of service delivery which increase capacity and provide rapid, safe, effective, affordable and sustainable health care. Design: A multi-method approach will measure current ICT impact on workforce practices and develop and test new models of ICT use which support innovations in work practice. The research will focus on three large-scale commercial ICT systems being adopted in Australia and other countries: computerised ordering systems, ambulatory electronic medical record systems, and emergency medicine information systems. We will measure and analyse each system's role in supporting five key attributes of work practice innovation: changes in professionals' roles and responsibilities; integration of best practice into routine care; safe care practices; team-based care delivery; and active involvement of consumers in care. Discussion: A socio-technical approach to the use of ICT will be adopted to examine and interpret the workforce and organisational complexities of the health sector. The project will also focus on ICT as a potentially disruptive innovation that challenges the way in which health care is delivered and consequently leads some health professionals to view it as a threat to traditional roles and responsibilities and a risk to existing models of care delivery. Such views have stifled debate as well as wider explorations of ICT's potential benefits, yet firm evidence of the effects of role changes on health service outcomes is limited. This project will provide important evidence about the role of ICT in supporting new models of care delivery across multiple healthcare organizations and about the ways in which innovative work practice change is diffused.
Annals of Emergency Medicine, Jun 1, 2013
Study objective: We undertake a systematic review of the quantitative literature related to the e... more Study objective: We undertake a systematic review of the quantitative literature related to the effect of computerized provider order entry systems in the emergency department (ED).
PubMed, 2011
Doctors are the main users of x-rays and other medical images in hospitals and as such picture ar... more Doctors are the main users of x-rays and other medical images in hospitals and as such picture archive and communication systems (PACS) have been designed to improve their work processes and clinical care by providing them with faster access to images. Nurses working in intensive care units (ICUs) also access images as an integral part of their work, yet no studies have examined the impact of PACS on the work of intensive care nurses. Our study aimed to examine whether and how ICU nurses view and use images and whether access to PACS promotes innovation in work practices. We interviewed (n=49) and observed (n=23) nurses in three Australian metropolitan teaching hospital ICUs with varying degrees of PACS implementation. Our study found that nurses with access to PACS were able to independently and easily access images, did so more frequently when required, and perceived that this had the potential to positively impact upon patient safety. Those without PACS usually viewed images more traditionally as part of a ward round. The introduction of PACS to ICU settings promotes changes in nursing work practices by providing nurses with the ability to act more autonomously, with the potential to enhance patient care.
Annals of Emergency Medicine, 2013
We undertake a systematic review of the quantitative literature related to the effect of computer... more We undertake a systematic review of the quantitative literature related to the effect of computerized provider order entry systems in the emergency department (ED). We searched MEDLINE, EMBASE, Inspec, CINAHL, and CPOE.org for English-language studies published between January 1990 and May 2011. We identified 1,063 articles, of which 22 met our inclusion criteria. Sixteen used a pre/post design; 2 were randomized controlled trials. Twelve studies reported outcomes related to patient flow/clinical work, 7 examined decision support systems, and 6 reported effects on patient safety. There were no studies that measured decision support systems and its effect on patient flow/clinical work. Computerized provider order entry was associated with an increase in time spent on computers (up to 16.2% for nurses and 11.3% for physicians), with no significant change in time spent on patient care. Computerized provider order entry with decision support systems was related to significant decreases in prescribing errors (ranging from 17 to 201 errors per 100 orders), potential adverse drug events (0.9 per 100 orders), and prescribing of excessive dosages (31% decrease for a targeted set of renal disease medications). There are tangible benefits associated with computerized provider order entry/decision support systems in the ED environment. Nevertheless, when considered as part of a framework of technical, clinical, and organizational components of the ED, the evidence base is neither consistent nor comprehensive. Multimethod research approaches (including qualitative research) can contribute to understanding of the multiple dimensions of ED care delivery, not as separate entities but as essential components of a highly integrated system of care. [
Bmc Health Services Research, Aug 11, 2009
Annals of Emergency Medicine, 2013
We undertake a systematic review of the quantitative literature related to the effect of computer... more We undertake a systematic review of the quantitative literature related to the effect of computerized provider order entry systems in the emergency department (ED). We searched MEDLINE, EMBASE, Inspec, CINAHL, and CPOE.org for English-language studies published between January 1990 and May 2011. We identified 1,063 articles, of which 22 met our inclusion criteria. Sixteen used a pre/post design; 2 were randomized controlled trials. Twelve studies reported outcomes related to patient flow/clinical work, 7 examined decision support systems, and 6 reported effects on patient safety. There were no studies that measured decision support systems and its effect on patient flow/clinical work. Computerized provider order entry was associated with an increase in time spent on computers (up to 16.2% for nurses and 11.3% for physicians), with no significant change in time spent on patient care. Computerized provider order entry with decision support systems was related to significant decreases in prescribing errors (ranging from 17 to 201 errors per 100 orders), potential adverse drug events (0.9 per 100 orders), and prescribing of excessive dosages (31% decrease for a targeted set of renal disease medications). There are tangible benefits associated with computerized provider order entry/decision support systems in the ED environment. Nevertheless, when considered as part of a framework of technical, clinical, and organizational components of the ED, the evidence base is neither consistent nor comprehensive. Multimethod research approaches (including qualitative research) can contribute to understanding of the multiple dimensions of ED care delivery, not as separate entities but as essential components of a highly integrated system of care.
Studies in Health Technology and Informatics, 2011
Doctors are the main users of x-rays and other medical images in hospitals and as such picture ar... more Doctors are the main users of x-rays and other medical images in hospitals and as such picture archive and communication systems (PACS) have been designed to improve their work processes and clinical care by providing them with faster access to images. Nurses working in intensive care units (ICUs) also access images as an integral part of their work, yet no studies have examined the impact of PACS on the work of intensive care nurses. Our study aimed to examine whether and how ICU nurses view and use images and whether access to PACS promotes innovation in work practices. We interviewed (n=49) and observed (n=23) nurses in three Australian metropolitan teaching hospital ICUs with varying degrees of PACS implementation. Our study found that nurses with access to PACS were able to independently and easily access images, did so more frequently when required, and perceived that this had the potential to positively impact upon patient safety. Those without PACS usually viewed images more traditionally as part of a ward round. The introduction of PACS to ICU settings promotes changes in nursing work practices by providing nurses with the ability to act more autonomously, with the potential to enhance patient care.
Studies in Health Technology and Informatics, 2012
The Intensive Care Unit (ICU) is an information intense environment where Clinical Information Sy... more The Intensive Care Unit (ICU) is an information intense environment where Clinical Information Systems (CISs) can greatly impact patient care and the workload of clinicians. With the introduction of an ICU CIS imminent across New South Wales hospitals, we aimed to understand how ICU clinicians perceived a new system would impact on work practices in Australian ICUs, as much of the current evidence is generated from overseas. We conducted interviews with 66 doctors and nurses in 3 ICUs without a CIS. Many had positive perceptions regarding the impact of its introduction, though others were more guarded and unsure. Clinicians believed information access to patient would improve, communication processes could potentially change and there was potential for work processes to be more efficient. It was expected that ward rounds and handover would be less disrupted with all information available at the bedside or at the handover setting. There were mixed responses about whether a CIS would save time and how it would influence patient care, though the majority believed a CIS would improve safety by providing a means for increasing accountability and reducing medication errors. Concerns were raised about the transition from paper to a CIS and the training required. This information provides valuable evidence in the Australian setting regarding clinicians' expectations of a new ICU CIS to assist with future implementations. It also provides baseline data as a foundation for future research once the CIS is implemented. It is clear that robust quantitative studies are required to gain a detailed understanding of how a new CIS will impact clinicians' work processes and that appropriate training is crucial for full benefits to be achieved.
Studies in Health Technology and Informatics, 2011
Picture Archiving and Communication Systems (PACS) allow the fast delivery of imaging studies to ... more Picture Archiving and Communication Systems (PACS) allow the fast delivery of imaging studies to clinicians at the point-of-care, supporting quicker decision-making. PACS has the potential to have a significant impact in the Intensive Care Unit (ICU) where critical decisions are made on a daily basis, particularly during ward rounds. We aimed to examine how accessing image information is integrated into ward rounds and if the presence of PACS produced innovations in ward round practices. We observed ward rounds and conducted interviews with ICU doctors at three hospitals with differing levels of PACS availability and computerization. Imaging results were infrequently viewed by clinicians during ward rounds in two ICUs: one without PACS and one which had both PACS and bedside computers. In the third ICU, where PACS was only available at a central workstation, images were frequently viewed throughout the daily round and integrated into decisions about patient care. The presence of bedside computers does not automatically result in innovations to work practice. Despite the ability to utilize PACS at the bedside to support decision-making, use was varied. Research to understand how the complexities and context of the ICU contribute to work practice innovation and why practice changes differ is required.
An important step in advancing global health through informatics is to understand how systems sup... more An important step in advancing global health through informatics is to understand how systems support health professionals to deliver improved services to patients. Studies in several countries have highlighted the potential for clinical information systems to change patterns of work and communication, and in particular have raised concerns that they reduce nurses' time in direct care. However measuring the effects of systems on work is challenging and comparisons across studies have been hindered by a lack of standardised definitions and measurement tools. This paper describes the Work Observation Method by Activity Time (WOMBAT) technique version 1.0 and the ways in which the data generated can describe different aspects of health professionals' work. In 2011 a revised WOMBAT version 2.0 was developed specifically to facilitate its use by research teams in different countries. The new features provide opportunities for international comparative studies of nurses' work to be conducted.
Studies in health technology and informatics, 2009
The Intensive Care Unit (ICU) is a complex and dynamic tertiary care environment that requires he... more The Intensive Care Unit (ICU) is a complex and dynamic tertiary care environment that requires health care providers to balance many competing tasks and responsibilities. Inefficient and interruption-driven workflow is believed to increase the likelihood of medical errors and, therefore, present a serious risk to patients in the ICU. The introduction of a Critical Care Information System (CCIS), is purported to result in fewer medical errors and better patient care by streamlining workflow. Little objective research, however, has investigated these assertions. This paper reports on the design of a research methodology to explore the impact of a CCIS on the workflow of Respiratory Therapists, Pediatric Intensivists, Nurses, and Unit Clerks in a Pediatric ICU (PICU) and a General Systems ICU (GSICU) in Northern Canada.
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Papers by Nerida Creswick