James Bordley1, Knewton K Sakata1, Jesse Bierman2, Karess McGrath1, Ashley Mulanax3, Linh Nguyen3, Vishnu Mohan4, Jeffrey A Gold1,4. 1. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health and Science University, Portland, OR. 2. Department of Pharmacy, Oregon Health and Science University, Portland, OR. 3. Department of Nursing, Oregon Health and Science University, Portland, OR. 4. Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR.
Abstract
OBJECTIVES: The electronic health record is a primary source of information for all professional groups participating in ICU rounds. We previously demonstrated that, individually, all professional groups involved in rounds have significant blind spots in recognition of patient safety issues in the electronic health record. However, it is unclear how team dynamics impacts identification and verbalization of viewed data. Therefore, we created an ICU rounding simulation to assess how the interprofessional team recognized and reported data and its impact on decision-making. DESIGN: Each member of the ICU team reviewed a simulated ICU chart in the electronic health record which contained embedded patient safety issues. The team conducted simulated rounds according to the ICU's existing rounding script and was assessed for recognition of safety issues. SETTING: Academic medical center. SUBJECTS: ICU residents, nurses, and pharmacists. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: Twenty-eight teams recognized 68.6% of safety issues with only 50% teams having the primary diagnosis in their differential. Individually, interns, nurses, and pharmacists recognized 30.4%, 15.6%, and 19.6% of safety items, respectively. However, there was a negative correlation between the intern's performance and the nurse's or the pharmacist's performance within a given team. The wide variance in recognition of data resulted in wide variance in orders. Overall, there were 21.8 orders requested and 21.6 orders placed per case resulting in 3.6 order entry inconsistencies/case. Between the two cases, there were 145 distinct orders place with 43% being unique to a specific team and only 2% placed by all teams. CONCLUSIONS: Although significant blind spots exist in the interprofessional team's ability to recognize safety issues in the electronic health record, the inclusion of other professional groups does serve as a partial safety net to improve recognition. Electronic health record-based, ICU rounding simulations can serve as a test-bed for innovations in ICU rounding structure and data collection.
OBJECTIVES: The electronic health record is a primary source of information for all professional groups participating in ICU rounds. We previously demonstrated that, individually, all professional groups involved in rounds have significant blind spots in recognition of patient safety issues in the electronic health record. However, it is unclear how team dynamics impacts identification and verbalization of viewed data. Therefore, we created an ICU rounding simulation to assess how the interprofessional team recognized and reported data and its impact on decision-making. DESIGN: Each member of the ICU team reviewed a simulated ICU chart in the electronic health record which contained embedded patient safety issues. The team conducted simulated rounds according to the ICU's existing rounding script and was assessed for recognition of safety issues. SETTING: Academic medical center. SUBJECTS: ICU residents, nurses, and pharmacists. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: Twenty-eight teams recognized 68.6% of safety issues with only 50% teams having the primary diagnosis in their differential. Individually, interns, nurses, and pharmacists recognized 30.4%, 15.6%, and 19.6% of safety items, respectively. However, there was a negative correlation between the intern's performance and the nurse's or the pharmacist's performance within a given team. The wide variance in recognition of data resulted in wide variance in orders. Overall, there were 21.8 orders requested and 21.6 orders placed per case resulting in 3.6 order entry inconsistencies/case. Between the two cases, there were 145 distinct orders place with 43% being unique to a specific team and only 2% placed by all teams. CONCLUSIONS: Although significant blind spots exist in the interprofessional team's ability to recognize safety issues in the electronic health record, the inclusion of other professional groups does serve as a partial safety net to improve recognition. Electronic health record-based, ICU rounding simulations can serve as a test-bed for innovations in ICU rounding structure and data collection.
Authors: E Ammenwerth; J Talmon; J S Ash; D W Bates; M-C Beuscart-Zéphir; A Duhamel; P L Elkin; R M Gardner; A Geissbuhler Journal: Methods Inf Med Date: 2006 Impact factor: 2.176
Authors: Melissa T Baysari; Johanna I Westbrook; Katrina L Richardson; Richard O Day Journal: J Am Med Inform Assoc Date: 2011-06-14 Impact factor: 4.497
Authors: Thomas G Kannampallil; Laura K Jones; Vimla L Patel; Timothy G Buchman; Amy Franklin Journal: J Am Med Inform Assoc Date: 2014-03-11 Impact factor: 4.497
Authors: Ross Koppel; Joshua P Metlay; Abigail Cohen; Brian Abaluck; A Russell Localio; Stephen E Kimmel; Brian L Strom Journal: JAMA Date: 2005-03-09 Impact factor: 56.272
Authors: Laurel S Stephenson; Adriel Gorsuch; William R Hersh; Vishnu Mohan; Jeffrey A Gold Journal: BMC Med Educ Date: 2014-10-21 Impact factor: 2.463
Authors: Sky Corby; Joan S Ash; Keaton Whittaker; Vishnu Mohan; Nicholas Solberg; James Becton; Robby Bergstrom; Benjamin Orwoll; Christopher Hoekstra; Jeffrey A Gold Journal: J Am Med Inform Assoc Date: 2022-09-12 Impact factor: 7.942