A sociotechnical systems-based analysis of documentation workflow in a pediatric emergency department

Abstract

The pediatric emergency department is a complex, interdisciplinary setting that requires highly skilled individuals to perform under intense time pressure despite numerous interruptions. The task of documentation consumes the majority of physicians' time and has evolved into an electronic communication tool for multiple providers. Documentation records information about diagnoses and treatments not only for treating the patient, but also for legal purposes. These factors underscore the importance of documentation clarity and accuracy. Considering the complexity of the pediatric emergency department, this project was conceptualized using the sociotechnical framework of the SEIPS 2.0 framework (Holden et al., 2013) and a mixed-methods ethnographic approach. Eleven attending physicians were followed for a total of 23 shifts. Data, both qualitative and quantitative, revealed the complexity of documentation and the unique relationships between attendings and residents, tools and technology, and the physical environment. Recommendations to mitigate negative outcomes are suggested, as well as application of this model and methodology for future research.