Christina L Cifra1, Cody R Tigges1, Sarah L Miller2, Nathaniel Curl3, Christopher D Monson1, Kimberly C Dukes4,5, Heather S Reisinger4,5,6, Priyadarshini R Pennathur5,7, Dean F Sittig8, Hardeep Singh9. 1. Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States. 2. Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States. 3. Emergency Medicine, UnityPoint Health-Trinity Medical Center, Rock Island, Illinois, United States. 4. Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center, Iowa City, Iowa, United States. 5. Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States. 6. Institute for Clinical and Translational Science, University of Iowa, Iowa City, Iowa, United States. 7. Department of Industrial and Systems Engineering, College of Engineering, University of Iowa, Iowa City, Iowa, United States. 8. School of Biomedical Informatics, Center for Healthcare Quality and Safety, University of Texas Health Science Center, Houston, Texas, United States. 9. Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas, United States.
Abstract
BACKGROUND: Many critically ill children are initially evaluated in front-line settings by clinicians with variable pediatric training before they are transferred to a pediatric intensive care unit (PICU). Because clinicians learn from past performance, communicating outcomes of patients back to front-line clinicians who provide pediatric emergency care could be valuable; however, referring clinicians do not consistently receive this important feedback. OBJECTIVES: Our aim was to determine the feasibility, usability, and clinical relevance of a semiautomated electronic health record (EHR)-supported system developed at a single institution to deliver timely and relevant PICU patient outcome feedback to referring emergency department (ED) physicians. METHODS: Guided by the Health Information Technology Safety Framework, we iteratively designed, implemented, and evaluated a semiautomated electronic feedback system leveraging the EHR in one institution. After conducting interviews and focus groups with stakeholders to understand the PICU-ED health care work system, we designed the EHR-supported feedback system by translating stakeholder, organizational, and usability objectives into feedback process and report requirements. Over 6 months, we completed three cycles of implementation and evaluation, wherein we analyzed EHR access logs, reviewed feedback reports sent, performed usability testing, and conducted physician interviews to determine the system's feasibility, usability, and clinical relevance. RESULTS: The EHR-supported feedback process is feasible with timely delivery and receipt of feedback reports. Usability testing revealed excellent Systems Usability Scale scores. According to physicians, the process was well-integrated into their clinical workflows and conferred minimal additional workload. Physicians also indicated that delivering and receiving consistent feedback was relevant to their clinical practice. CONCLUSION: An EHR-supported system to deliver timely and relevant PICU patient outcome feedback to referring ED physicians was feasible, usable, and important to physicians. Future work is needed to evaluate impact on clinical practice and patient outcomes and to investigate applicability to other clinical settings involved in similar care transitions. Thieme. All rights reserved.
BACKGROUND: Many critically ill children are initially evaluated in front-line settings by clinicians with variable pediatric training before they are transferred to a pediatric intensive care unit (PICU). Because clinicians learn from past performance, communicating outcomes of patients back to front-line clinicians who provide pediatric emergency care could be valuable; however, referring clinicians do not consistently receive this important feedback. OBJECTIVES: Our aim was to determine the feasibility, usability, and clinical relevance of a semiautomated electronic health record (EHR)-supported system developed at a single institution to deliver timely and relevant PICU patient outcome feedback to referring emergency department (ED) physicians. METHODS: Guided by the Health Information Technology Safety Framework, we iteratively designed, implemented, and evaluated a semiautomated electronic feedback system leveraging the EHR in one institution. After conducting interviews and focus groups with stakeholders to understand the PICU-ED health care work system, we designed the EHR-supported feedback system by translating stakeholder, organizational, and usability objectives into feedback process and report requirements. Over 6 months, we completed three cycles of implementation and evaluation, wherein we analyzed EHR access logs, reviewed feedback reports sent, performed usability testing, and conducted physician interviews to determine the system's feasibility, usability, and clinical relevance. RESULTS: The EHR-supported feedback process is feasible with timely delivery and receipt of feedback reports. Usability testing revealed excellent Systems Usability Scale scores. According to physicians, the process was well-integrated into their clinical workflows and conferred minimal additional workload. Physicians also indicated that delivering and receiving consistent feedback was relevant to their clinical practice. CONCLUSION: An EHR-supported system to deliver timely and relevant PICU patient outcome feedback to referring ED physicians was feasible, usable, and important to physicians. Future work is needed to evaluate impact on clinical practice and patient outcomes and to investigate applicability to other clinical settings involved in similar care transitions. Thieme. All rights reserved.
Authors: April Savoy; Laura G Militello; Himalaya Patel; Mindy E Flanagan; Alissa L Russ; Joanne K Daggy; Michael Weiner; Jason J Saleem Journal: J Biomed Inform Date: 2018-07-30 Impact factor: 6.317
Authors: Ayse Akcan Arikan; Eric A Williams; Jeanine M Graf; Curtis E Kennedy; Binita Patel; Andrea T Cruz Journal: J Pediatr Date: 2015-09-26 Impact factor: 4.406