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Clinical information system, Work sampling, Intensive care unit, Nursing activities



  1. Marasovic, Caroline RN, BNurs
  2. Kenney, Christopher RN, BNurs
  3. Elliott, Doug RN, BAppSc, MAppSc
  4. Sindhusake, Doungkamol MSc


This article describes a comparative study that examined the frequencies of nursing activities, when using a clinical information system (CIS) and a paper-based documentation system in an Australian intensive care unit. The study unit had half the beds equipped with a CIS, and the remaining beds used paper documentation. Work sampling methodology was used to observe nurses working with both systems. Though there were differences for all activities between the environments and the directions of the differences were logical, none were statistically significant using a chi-square test (P = .11-0.65), probably because of the small sample size. This study established that work sampling methodology using a random timer is a valid and relatively easy method to capture work activity in the clinical area. Although this article does not provide definitive information regarding the benefits of a CIS over manual documentation, a number of important methodological issues are discussed, including the study design, procedure, use of dedicated observers, and the distinction between basic versus fully optioned systems. Future research should evaluate the efficiency, impact on patient outcomes and nursing practice, and cost effectiveness of fully optioned systems.


Clinical information systems (CIS) have the ability to replace traditional paper medical records with computerized charting and notes, thus affecting the work activities of intensive care nurses. However, these systems are expensive to purchase and maintain, and benefits must be balanced against cost. One advantage of a CIS, as claimed by various vendors, is the time savings in documentation and review and retrieval of patient information. To evaluate this claim, a study was undertaken to determine whether there were differences in the frequency of activities of nursing staff when using the CIS compared with paper-based documentation.