Communication and sense-making in intensive care: an observation study of multi-disciplinary rounds to design computerized supporting tools.

Multi-disciplinary rounds are a forum for communication and sense-making, and they play a critical role in intensive care to ensure care coordination across specialties and providers. Increased availability of clinical information through computers has made it possible to provide support during rounds. We conducted an observation study to determine ways in which computers may be used during rounds, when users are under time pressure in accessing and manipulating clinical data. A total of fifteen hours of rounds in a pediatric intensive care unit for 47 patients were observed. Factors influencing information transfer during rounds were characterized in three areas: physical, social and cognitive, and supporting artifacts. Based on these factors we developed a set of design guidelines for computerized supporting tools. An example guideline suggests digital capture of handwritten notes. These guidelines developed may help guide future systems development, thus leveraging the power of computing during the critical moments of multi-disciplinary rounds.