Electronic patient record use during ward rounds: a qualitative study of interaction between medical staff

Morrison, Cecily; Jones, Matthew; Blackwell, Alan F.; Vuylsteke, Alain

doi:10.1186/cc7134

Cited by 59 publications

(47 citation statements)

References 15 publications

(12 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Time constraints, exacerbated by duty hour reforms, put pressure on attending physicians to expedite rounds and prioritize medical education over the inclusion of their non-physician colleagues. Similarly, the organization of MIRs attendees and equipment in the ICU hallway-in concentric circles that located physicians in the center, and nonphysicians on the periphery-limited participants' ability to collaborate by creating a physical barrier to communication (Morrison et al 2008). This barrier of white coats seemed to promote a combative relationship between provider groups by making professional identity more visible and more salient, thereby creating barriers to collaborative working during MIRs (Burford 2012).…”

Section: Discussionmentioning

confidence: 99%

Interprofessional rhetoric and operational realities: an ethnographic study of rounds in four intensive care units

Paradis

Leslie

Gropper

2015

Adv in Health Sci Educ

View full text Add to dashboard Cite

Morning interprofessional rounds (MIRs) are used in critical care medicine to improve team-based care and patient outcomes. Given existing evidence of conflict between and dissatisfaction among rounds participants, this study sought to better understand how the operational realities of care delivery in the intensive care unit (ICU) impact the success of MIRs. We conducted a year-long comparative ethnographic study of interprofessional collaboration and patient and family involvement in four ICUs in tertiary academic hospitals in two American cities. The study included 576 h of observation of team interactions, 47 shadowing sessions and 40 clinician interviews. In line with best practices in ethnographic research, data collection and analysis were done iteratively using the constant comparative method. Member check was conducted regularly throughout the project. MIRs were implemented on all units with the explicit goals of improving team-based and patient-centered care. Operational conditions on the units, despite interprofessional commitment and engagement, appeared to thwart ICU teams from achieving these goals. Specifically, time constraints, struggles over space, and conflicts between MIRs' educational and care-plan-development functions all prevented teams from achieving collaboration and patient-involvement. Moreover, physicians' de facto control of rounds often meant that they resembled medical rounds (their historical predecessors), and sidelined other providers' contributions. This study suggests that the MIRs model, as presently practiced, might not be well suited to the provision of team-based, patient-centered care. In the interest of interprofessional collaboration, of the optimization of clinicians' time, of high-quality medical education and of patient-centered care, further research on interprofessional rounds models is needed.

show abstract

Section: Discussionmentioning

confidence: 99%

Interprofessional rhetoric and operational realities: an ethnographic study of rounds in four intensive care units

Paradis

Leslie

Gropper

2015

Adv in Health Sci Educ

View full text Add to dashboard Cite

show abstract

“…There are also a number of studies that examine the impact of technology on healthcare professional work per se but which place little emphasis on the conditions under which it enables or constrains change or the possibility of technology enactment once introduced (Aarts et al, 2007;Abraham & Junglas, 2011;Harding & Taylor, 1997;Håland, 2011;Morrison et al, 2008;Reich, 2012;Vikkelsø, 2005). For example, Håland (2011) examined how the introduction of an EPR in a Norwegian hospital affected clinical work practices and the identities of doctors, nurses and secretaries without considering explicitly the agency of technology in this process of change.…”

Section: A Theory Of Technological Affordancesmentioning

confidence: 99%

Changes in healthcare professional work afforded by technology: The introduction of a national electronic patient record in an English hospital

2014

View full text Add to dashboard Cite

This article considers changes in healthcare professional work afforded by technology. It uses the sociology of professionals' literature together with a theory of affordances to examine how and when technology allows change in healthcare professional work. The study draws from research into the introduction of a national electronic patient record in an English hospital. We argue that electronic patient record affords changes through its materiality as it interacts with healthcare professional practice. Its affordances entail some level of standardisation of healthcare professional conduct and practice, curtailment of professional autonomy, enlargement of nurses' roles and redistribution of clinical work within and across professional boundaries. The article makes a contribution to the growing literature advocating a cultural approach to the study of technological affordances in organisations and to studies that explore healthcare professional practice in conjunction with the materiality of technology. Two main lines of argument are developed here. First, that technological affordances do not solely lie with the materiality of technology nor with individual perceptions, but are cultivated and nurtured within a broader cultural-institutional context, in our case a professional context of use. Second, that technological affordance of change is realised when healthcare professionals' (individual and collective) perceptions of technology (and of its materiality) fit with their sense of (professional) self. In this respect, the article shows the extent to which the materiality of technology plays out with professional identity and frames

show abstract

“…Morrison and colleagues [21] have carried out perhaps the most empirically-grounded study of the impact of a technological intervention on the structure of F-formations in their comparison of hospital ward rounds carried out before and after the introduction of electronic patient records. They describe how the diminished visibility of the electronic records on a small screen, compared with paper, impacted both the ability of consultants to lead discussion and of other medical staff to participate in the conversation.…”

Section: Background F-formations In Social Interactionmentioning

confidence: 99%

Using F-formations to analyse spatial patterns of interaction in physical environments

Marshall

Rogers

Pantidi

2011

Proceedings of the ACM 2011 Conference on Computer Supported Cooperative Work

116

View full text Add to dashboard Cite

There are few conceptual tools available to analyse physical spaces in terms of their support for social interactions and their potential for technological augmentation. In this paper, we describe how we used Adam Kendon's characterisation of the F-formation system of spatial organisation as a conceptual lens to analyse the social interactions between visitors and staff in a tourist information centre. We describe how the physical structures in the space encouraged and discouraged particular kinds of interactions and discuss how F-formations might be used to think about augmenting physical spaces.

show abstract

Electronic patient record use during ward rounds: a qualitative study of interaction between medical staff

Cited by 59 publications

References 15 publications

Interprofessional rhetoric and operational realities: an ethnographic study of rounds in four intensive care units

Interprofessional rhetoric and operational realities: an ethnographic study of rounds in four intensive care units

Changes in healthcare professional work afforded by technology: The introduction of a national electronic patient record in an English hospital

Using F-formations to analyse spatial patterns of interaction in physical environments

Contact Info

Product

Resources

About