Professional and interprofessional differences in electronic health records use and recognition of safety issues in critically ill patients

Abstract

During interprofessional intensive care unit (ICU) rounds each member of the interprofessional team is responsible for gathering and interpreting information from the electronic health records (EHR) to facilitate effective team decision-making. This study was conducted to determine how each professional group reviews EHR data in preparation for rounds and their ability to identify patient safety issues. Twenty-five physicians, 29 nurses, and 20 pharmacists participated. Individual participants were given verbal and written sign-out and then asked to review a simulated record in our institution's EHR, which contained 14 patient safety items. After reviewing the chart, subjects presented the patient and the number of safety items recognised was recorded. About 40%, 30%, and 26% of safety issues were recognised by physicians, nurses, and pharmacists, respectively (p = 0.0006) and no item recognised 100% of the time. There was little overlap between the three groups with only 50% of items predicted to be recognised 100% of the time by the team. Differential recognition was associated with marked differences in EHR use, with only 3/152 EHR screens utilised by all three groups and the majority of screens used exclusively only by one group. There were significant and non-overlapping differences in individual profession recognition of patient safety issues in the EHR. Preferential identification of safety issues by certain professional groups may be attributed to differences in EHR use. Future studies will be needed to determine if shared decision-making during rounds can improve recognition of safety issues.

Impact of a Web-Based Electronic Health Record on Behavioral Health Service Delivery for Children and Adolescents: Randomized Controlled Trial

“…Accordingly, research on EHRs in general healthcare has proliferated over the past decade. Research has examined rates of uptake of EHR systems and related HIT across healthcare settings [ 9 - 11 ], illuminated factors related to adoption and perceived usability [ 6 , 9 ], and enumerated barriers, challenges, and strategies to promote implementation [ 4 - 7 , 12 , 13 ]. Importantly, research has also examined impacts of EHR adoption, with comprehensive reviews showing a mix of positive, negative, and null outcomes.…”

Use of Simulation Based on an Electronic Health Records Environment to Evaluate the Structure and Accuracy of Notes Generated by Medical Scribes: Proof-of-Concept Study

“…One key factor that contributes to the dissatisfaction is the paradigm of “information chaos” resulting from EHR use that can lead to impaired situational awareness and increased mental workload [ 3 ]. To amplify this paradigm, a number of studies conducted by our group and others have suggested that providers across multiple professions have difficulty in using the EHR as manifested by issues with data finding, recognition of patient safety issues, and impairment in clinical decision making [ 4 , 5 ]. Additionally, recent studies revealed that problems associated with clinicians’ selective data gathering or selective data interpretation can lead to increased patient harm, a phenomenon that has also been identified and replicated in simulation exercises [ 6 , 7 ].…”

“…Additionally, recent studies revealed that problems associated with clinicians’ selective data gathering or selective data interpretation can lead to increased patient harm, a phenomenon that has also been identified and replicated in simulation exercises [ 6 , 7 ]. These issues are not just isolated to physicians: recent work from our group has suggested that the phenomenon affects nurses and pharmacists at all levels of training, implying a global problem related to human EHR interfaces [ 5 , 8 ].…”

“…On the basis of these concerns, it is imperative that methodology exists to ensure that scribes can be effectively trained and their competency assessed for safe and effective use of EHR in the appropriate clinical settings. Simulation has been a means of evaluating complicated systems, while posing no risk to patients, and providing high-fidelity standardized subject experiences [ 4 , 5 ]. Recently, we demonstrated that EHR-based simulation could be used to assess the creation and accuracy of both intern progress notes and admission history and physicals [ 16 , 17 ].…”

Use of a Novel, Electronic Health Record–Centered, Interprofessional ICU Rounding Simulation to Understand Latent Safety Issues*

“…Despite widespread adoption, the EHR introduces a social-technical dynamic to rounds that remains poorly understood [10]. We previously published that physicians, nurses and pharmacists when tested individually, all have significant, non-overlapping blind spots in recognizing critical patient safety issues during EHR based simulation [11,12]. However, little is known about how these differences in data collection interact when the team comes together to collectively care for a patient on rounds.…”