THE COMPUTER-BASED PATIENT CHART - A WORK PLACE ANALYSIS

Since 1991, an extensive computer network has been developed and imple mented at the Cantonal Hospital of Lucerne. The medical applications i nclude computer aided management of patient charts, medical correspond ence, and compilation of diagnosis statistics according to the ICD-9 c ode. In 1992, the system was introduced as a pilot project in the depa rtments of pediatrics and pediatric surgery of the Lucerne Children's Hospital. This new system has been prospectively evaluated using a wor kplace analysis. The time taken to complete patient charts and surgica l reports was recorded for 14 days before and after the introduction o f the computerized system. This analysis was performed for both physic ians and secretarial staff. The time delay between the discharge of th e patient and the mailing of the discharge letter to the family doctor was also recorded. By conventional means, the average time for the ph ysician to generate a patient chart (26 minutes, n = 119) was slightly lower than the time needed with the computer system (28 minutes, n = 177). However, for a discharge letter, the time needed by the physicia n was reduced by one third with the computer system and by more than o ne half for the secretarial staff (32 and 66 minutes conventionally; 2 2 and 24 minutes respectively with the computer system; p <0.0001). Th e time required for the generation of surgical reports was reduced fro m 17 to 13 minutes per patient and the processing time by secretaries from 37 to 14 minutes. The time delay between the discharge of the pat ient and the mailing of the discharge letter was reduced by 50% from 7 .6 to 3.9 days. The administration of patient charts using a computer network system produced a mean saving of 49 minutes per hospitalized p atient, of which 15% can be attributed to physicians and 85% to secret arial staff.