Accuracy of Laboratory Data Communication on ICU Daily Rounds Using an Electronic Health Record*

Artis, Kathryn A.; Dyer, Edward; Mohan, Vishnu; Gold, Jeffrey A.

doi:10.1097/ccm.0000000000002060

Cited by 18 publications

(27 citation statements)

References 34 publications

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“…The attendance of ward rounds necessitates the conduct of physical examinations, retrieval of patient information, and communication with other health care providers to make optimal decisions [ 27 - 29 , 36 ]. Because the ward round is such an active process, the most updated information should be exchanged, as doctors visit each patient [ 37 ]. Moreover, efficient information exchange and communication can lead to effective work and rational decision making [ 38 , 39 ].…”

Section: Discussionmentioning

confidence: 99%

“…Among the doctors, the most frequently accessed service was the “inpatient list,” followed by “lab results” ( Table 1 ). These results showed that checking real-time lab results is important, as it may require immediate action [ 37 ]. Moreover, this implies that easier access to the lab results of patients of special concern, such as patients in critical conditions, may facilitate a more efficient workflow [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

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Usage Pattern Differences and Similarities of Mobile Electronic Medical Records Among Health Care Providers

Lee¹,

Park²,

Kim³

et al. 2017

JMIR Mhealth Uhealth

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BackgroundRecently, many hospitals have introduced mobile electronic medical records (mEMRs). Although numerous studies have been published on the usability or usage patterns of mEMRs through user surveys, investigations based on the real data usage are lacking.ObjectiveAsan Medical Center, a tertiary hospital in Seoul, Korea, implemented an mEMR program in 2010. On the basis of the mEMR usage log data collected over a period of 4.5 years, we aimed to identify a usage pattern and trends in accordance with user occupation and to disseminate the factors that make the mEMR more effective and efficient.MethodsThe mEMR log data were collected from March 2012 to August 2016. Descriptive analyses were completed according to user occupation, access time, services, and wireless network type. Specifically, analyses targeted were as follows: (1) the status of the mEMR usage and distribution of users, (2) trends in the number of users and usage amount, (3) 24-hour usage patterns, and (4) trends in service usage based on user occupations. Linear regressions were performed to model the relationship between the time, access frequency, and the number of users. The differences between the user occupations were examined using Student t tests for categorical variables.ResultsApproximately two-thirds of the doctors and nurses used the mEMR. The number of logs studied was 7,144,459. Among 3859 users, 2333 (60.46%) users were nurses and 1102 (28.56%) users were doctors. On average, the mEMR was used 1044 times by 438 users per day. The number of users and amount of access logs have significantly increased since 2012 (P<.001). Nurses used the mEMR 3 times more often than doctors. The use of mEMR by nurses increased by an annual average of 51.5%, but use by doctors decreased by an annual average of 7.7%. For doctors, the peak usage periods were observed during 08:00 to 09:00 and 17:00 to 18:00, which were coincident with the beginning of ward rounds. Conversely, the peak usage periods for the nurses were observed during 05:00 to 06:00, 12:00 to 13:00, and 20:00 to 21:00, which effectively occurred 1 or 2 hours before handover. In more than 80% of all cases, the mEMR was accessed via a nonhospital wireless network.ConclusionsThe usage patterns of the mEMR differed between doctors and nurses according to their different workflows. In both occupations, mEMR was highly used when personal computer access was limited and the need for patient information was high, such as during ward rounds or handover periods.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Usage Pattern Differences and Similarities of Mobile Electronic Medical Records Among Health Care Providers

Lee¹,

Park²,

Kim³

et al. 2017

JMIR Mhealth Uhealth

View full text Add to dashboard Cite

show abstract

“…5,6 On the other, thorough clinical review and processing of patient data retrieved from the EHR is important, as studies have shown that data gathering for daily intensive care unit (ICU) rounds is prone to omissions and inaccuracies. 7 In addition, previous research has also shown that inadequate analysis leads to diagnostic error and patient harm. 8 In the pediatric critical care literature, studies on EHR data collection and usage are sparse.…”

Section: Background and Significancementioning

confidence: 99%

Impact of Patient Census and Admission Mortality on Pediatric Intensive Care Unit Attending Electronic Health Record Activity: A Preliminary Study

et al. 2020

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Background Physicians may spend a significant amount of time using the electronic health record (EHR), but this is understudied in the pediatric intensive care unit (PICU). The objective of this study is to quantify PICU attending physician EHR usage and determine its association with patient census and mortality scores. Methods During the year 2016, total EHR, chart review, and documentation times of 7 PICU physicians were collected retrospectively utilizing an EHR-embedded time tracking software package. We examined associations between documentation times and patient census and maximum admission mortality scores. Odds ratios (ORs) are reported per 1-unit increase in patient census and mortality scores. Results Overall, total daily EHR usage time (median time [hh:mm] [25th, 75th percentile]) was 2:10 (1:31, 3:08). For all hours (8 a.m.–8 a.m.), no strong association was noted between total EHR time, chart review, and documentation times and patient census, Pediatric Index of Mortality 2 (PIM2), or Pediatric Risk of Mortality 3 (PRISM3) scores. For regular hours (8 a.m.–7 p.m.), no strong association was noted between total EHR, chart review, and documentation times and patient census, PIM2, or PRISM3 scores. When patient census was higher, the odds of EHR after-hour usage (7 p.m.–8 a.m.) was higher (OR 1.262 [1.135, 1.403], p < 0.0001), but there were no increased odds with PIM2 (OR 1.090 [0.956, 1.242], p = 0.20) and PRISM3 (OR 1.010 [0.984, 1.036], p = 0.47) scores. A subset of physicians spent less time performing EHR-related tasks when patient census and admission mortality scores were elevated. Conclusion We performed a novel evaluation of physician EHR workflow in our PICU. Our pediatric critical care physicians spend approximately 2 hours (out of an expected 10-hour shift) each service day using the EHR, but there was no strong or consistent association between EHR usage and patient census or mortality scores. Future larger scale studies are needed to ensure validity of these results.

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“…Unsurprisingly, faulty communication is frequently cited as contributing to medical errors in the health care setting. [2][3][4][5] These errors have real effects not only on the clinical outcomes of care and satisfaction of patients but also impact quality of care, patient safety, and now carry financial repercussions for hospitals and health care organizations. 6 Currently, there exist significant and persistent barriers to connecting providers in complex inpatient systems quickly and reliably meaning communication remains a central problem in improving in health care systems.…”

Section: Background and Significancementioning

confidence: 99%

Inpatient Communication Networks: Leveraging Secure Text-Messaging Platforms to Gain Insight into Inpatient Communication Systems

et al. 2019

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Objective This study attempts to characterize the inpatient communication network within a quaternary pediatric academic medical center by applying network analysis methods to secure text-messaging data. Methods We used network graphing and statistical software to create network models of an inpatient communication system with secure text-messaging data from physicians, nurses, and other ancillary staff in an academic medical center. Descriptive statistics about the network, users within the network, and visualizations informed the team's understanding of the network and its components. Results Analysis of messages exchanged over approximately 23 days revealed a large, scale-free network with 4,442 nodes and 59,913 edges. Quantitative description of user behavior (messages sent and received) and network metrics (i.e., importance of nodes within a network) revealed several operational and clinical roles both sending and receiving > 1,000 messages over this time period. While some of these nodes represented expected “dispatcher” roles in our inpatient system, others occupied important frontline clinical roles responsible for bedside clinical care. Conclusion Quantitative and network analysis of secure text-messaging logs revealed several key operational and clinical roles at risk for alert fatigue and information overload. This analysis also revealed a communication network highly reliant on these key roles, meaning disruption to these individuals or their workflows could lead to dysfunction of the communication network. While secure text-messaging applications play increasingly important roles in facilitating inpatient communication, little is understood about the impact these systems have on health care providers. Developing methods to understand and optimize communication between inpatient providers might help operational and clinical leaders to proactively prevent poorly understood pitfalls associated with these systems and build resilient and effective communication structures.

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Accuracy of Laboratory Data Communication on ICU Daily Rounds Using an Electronic Health Record*

Abstract: Supplemental Digital Content is available in the text.

Cited by 18 publications

References 34 publications

Usage Pattern Differences and Similarities of Mobile Electronic Medical Records Among Health Care Providers

Usage Pattern Differences and Similarities of Mobile Electronic Medical Records Among Health Care Providers

Impact of Patient Census and Admission Mortality on Pediatric Intensive Care Unit Attending Electronic Health Record Activity: A Preliminary Study

Inpatient Communication Networks: Leveraging Secure Text-Messaging Platforms to Gain Insight into Inpatient Communication Systems

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