@文章{信息:doi/10.2196/37472，作者=“Jewer, Jennifer”，标题=“研究急诊科高峰管理系统的工作系统方法:案例研究”，期刊=“J Med Internet Res”，年=“2022”，月=“8”，日=“25”，卷=“24”，号=“8”，页=“e37472”，关键词=“急诊科;增加管理;工作系统;系统实现;急诊部信息系统;背景:急诊科(ED)拥挤是一个全球性的卫生保健问题。电子卫生系统有可能减少拥挤;然而，真正的好处很少实现，因为系统没有集成到临床医生的工作。我们希望深入了解如何构建电子健康系统，以便将系统真正集成到工作流程中。目的:本研究的具体目的是检验工作系统理论(WST)是否是一种很好的方法，通过将整个工作系统，而不仅仅是电子卫生系统，纳入实施框架; identify the role that specific elements of WST's static framework and dynamic work system life cycle model play in the implementation; and demonstrate how WST can be applied in the health care setting to guide the implementation of an eHealth system. Methods: Through a case study of an ED in a rural hospital, we used a mixed methods approach to examine the implementation of a surge management system through the lens of WST. We conducted 14 hours of observation in the ED; 20 interviews with clinicians, management, and members of the implementation team; and a survey of 23 clinicians; reviewed related documentation; and analyzed ED data to measure wait times. We used template analysis based on WST to structure our analysis of qualitative data and descriptive statistics for quantitative data. Results: The surge management system helped to reduce crowding in the ED, staff was satisfied with the implementation, and wait time improvements have been maintained for several years. Although study participants indicated changes to their workflow, 72{\%} (13/18) of survey participants were satisfied with their use of the system, and 82{\%} (14/17) indicated that it was integrated with their workflow. Examining the implementation through the lens of WST enabled us to identify the aspects of the implementation that made it so successful. By applying the WST static framework, we saw how the implementation team incorporated the elements of the ED work system, assessed their alignment, and designed interventions to address areas of misalignment. The dynamic work system life cycle model captured how planned and unplanned changes were managed throughout the iterative implementation cycle---83{\%} (15/18) of participants indicated that there was sufficient management support for the changes and 80{\%} (16/20) indicated the change served an important purpose. Conclusions: The broad scope and holistic approach of WST is well suited to guide eHealth system implementations as it focuses efforts on the entire work system and not just the IT artifact. We broaden the focus of WST by applying it to the implementation of an ED surge management system. These findings will guide further studies and implementations of eHealth systems using WST. ", issn="1438-8871", doi="10.2196/37472", url="//www.mybigtv.com/2022/8/e37472", url="https://doi.org/10.2196/37472", url="http://www.ncbi.nlm.nih.gov/pubmed/36006684" }