What impact do emergency department information systems have on nurses' access to information? A qualitative analysis of nurses' use and perceptions of a fully integrated clinical information system

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 efficiently access and record patient information in order to both provide treatment to patients, communicate information to other health professionals and to manage patient flow through the department. Information not available to ED clinicians has been shown to be associated with longer patient stays in the ED. Therefore ED clinicians require well organised and easily accessed clinical and administrative information. Electronic clinical information systems have the capability to facilitate improved access to information, however few studies have examined whether this potential is being realised, particularly by nurses. Methods: Within a socio-technical framework, a qualitative study design was employed using semi-structured interviews and a focus group to explore ED nurses' use and perceptions of an integrated ED clinical information system. The study was conducted at one Australian metropolitan public hospital ED. Four senior nurses were interviewed and seven nurses with a range of roles participated in the focus group. Results: The results presented in this paper relate to nurses' perceptions of the impact of the technology on 'access to information'. This was one of the themes elicited from the data. The results showed that with an areawide integrated ED clinical information system nurses perceived that they had improved ease of access to information, such as test results and previous electronic discharge summaries which impacted positively on patient care and on their roles as ED nurses. Discussion and conclusions: The increased volume of information and the improved ease of access to clinical, knowledge-based and administrative information supports ED nurses in practicing evidence-based nursing, which they report contributes to providing higher quality patient care. The clinical information system provides a means of asynchronous communication between health professionals reducing unnecessary interruptions. Increased access to information was also perceived as allowing nurses to take on extended roles in patient management. With access to the same information as doctors the nurses perceived that they had increased autonomy in their work. This study highlighted the value of technology in facilitating improved clinical information access for ED nurses.