Table 1.
Findings and recommendations following a task analysis
| No | Task | Prov | Tm | Com | IT | Findings - Problems | Recommendations |
|---|---|---|---|---|---|---|---|
| Pre-triage | |||||||
| 1 | ID patient | Pre-Triage Nurse | 1–2 minutes | Per | N | Privacy concerns; misspelled names may cause multiple entries in EMR | Separate from waiting room; electronic entry of pt. names |
| 2 | Urgency | N | No decision support; patient history and practice guidelines not accessible | Integrated tracking and EMR systems for immediate recall | |||
| 3 | Patient Destination | Per | N | Waiting room activity not monitored; no direct communication with fast-track | Pts may be given bracelets; alerts to fast-track personnel | ||
| 4 | Paper form | Wrt | N | Legibility; single copy for all clinicians | Replace by electronic system | ||
| Triage | |||||||
| 5 | Assessment | Triage Nurse | 12 minutes | Per
Wrt |
N | Interpreter inaccessible; EMR with visit history unavailable; no guidelines | Communication via PC or intercom; electronic guideline |
| 6 | Vitals | Wrt | N | Done by nurse if technician unavailable | |||
| 7 | Triage category | Wrt
Per |
N | No decision support available; patient EMR history, allergies unavailable | EMR may be ready from pre-traige stage for overview | ||
| 8 | Tests | Wrt | N | Paper ordering in place; execution of quick tests like blood sugar level | Replace by computer-based ordering system | ||
| 9 | Tracking | Elc | Y | Duplication of data from paper; manual updates of state not always accurate | Integrated system with EMR; automatic updates via RFID | ||
| 10 | Workload estimate | Per
Elc |
Y | Cognitively difficult; requires calls when tracking system is not updated | Tracking can automate this with algorithms and updates | ||
| 11 | Patient Destination | Per
Elc |
Y | Awareness of current overall workload of district nurses required | Tracking system to allocate patients to appropriate area | ||
| ED Transfer | |||||||
| 12 | Find a bed | Triage Nurse | 3 minutes | Per | N | Often unavailable, patients crowded around main desk area on chairs | Electronic tracking to signal availability of beds sooner |
| 13 | Find district nurse | Per | N | Nurses have workload of 10–15 pts and can be at many locations | Personal RFID tracking and reporting, wireless alerts | ||
| 14 | Present patient | Per | N | When the patient case explained, chart is often not available (at registration) | Integrated tracking and EMR available in real time to all | ||
| Registration | |||||||
| 15 | Copy form to EMR | Clerk | ? | Elc
Wrt |
Y | Second manual copying of pt data; transcript errors; duplication of records | Electronic chart updated anytime during the visit |
Legend: Prov-Provider; Tm-Duration; Com-Communication; IT-Comp. support available; Per-Personal; Wrt-Written; Elc-Electronic;