Improving Clinician Decisions and Communication in Critical Care Using Novel Information Technology

Abstract

Introduction The electronic medical record (EMR) is presumed to support clinician decisions by documenting and retrieving patient information. Research shows that the EMR variably affects patient care and clinical decision making. The way information is presented likely has a significant impact on this variability. Well-designed representations of salient information can make a task easier by integrating information in useful patterns that clinicians use to make improved clinical judgments and decisions. Using Cognitive Systems Engineering methods, our research team developed a novel health information technology (NHIT) that interfaces with the EMR to display salient clinical information and enabled communication with a dedicated text-messaging feature. The software allows clinicians to customize displays according to their role and information needs. Here we present results of usability and validation assessments of the NHIT. Materials and Methods Our subjects were physicians, nurses, respiratory therapists, and physician trainees. Two arms of this study were conducted, a usability assessment and then a validation assessment. The usability assessment was a computer-based simulation using deceased patient data. After a brief five-minute orientation, the usability assessment measured individual clinician performance of typical tasks in two clinical scenarios using the NHIT. The clinical scenarios included patient admission to the unit and patient readiness for surgery. We evaluated clinician perspective about the NHIT after completing tasks using 7-point Likert scale surveys. In the usability assessment, the primary outcome was participant perceptions about the system’s ease of use compared to the legacy system. A subsequent cross-over, validation assessment compared performance of two clinical teams during simulated care scenarios: one using only the legacy IT system and one using the NHIT in addition to the legacy IT system. We oriented both teams to the NHIT during a 1-hour session on the night before the first scenario. Scenarios were conducted using high-fidelity simulation in a real burn intensive care unit room. We used observations, task completion times, semi-structured interviews, and surveys to compare user decisions and perceptions about their performance. The primary outcome for the validation assessment was time to reach accurate (correct) decision points. Results During the usability assessment, clinicians were able to complete all tasks requested. Clinicians reported the NHIT was easier to use and the novel information display allowed for easier data interpretation compared to subject recollection of the legacy EMR. In the validation assessment, a more junior team of clinicians using the NHIT arrived at accurate diagnoses and decision points at similar times as a more experienced team. Both teams noted improved communication between team members when using the NHIT and overall rated the NHIT as easier to use than the legacy EMR, especially with respect to finding information. Conclusions The primary findings of these assessments are that clinicians found the NHIT easy to use despite minimal training and experience and that it did not degrade clinician efficiency or decision-making accuracy. These findings are in contrast to common user experiences when introduced to new EMRs in clinical practice.

A Communication Model to Bridge Adolescent Patients, Caregivers, and Physicians in Transitions of Care

“…Prior communication studies on care transitions between providers, pediatric patients, and their caregivers that focus on patients with complex care needs (Dickert & Kass, 2009;Giambra et al, 2017;Gudzune et al, 2013;Lipstein et al, 2014;Persson & Newman, 2012) suggest that effective communication (Healthy People 2020, 2019Marginean et al, 2017;Rasmussen et al, 2007), building rapport (Gudzune et al, 2013;Rasmussen et al, 2007), and continuity of care (Giambra et al, 2017;Rasmussen et al, 2007) influence the quality of patients' health and health care. Information sharing between patient, caregiver, and provider is essential to improving health outcomes (Healthy People 2020, 2019Lipstein et al, 2014;Street et al, 2009). The adapted communication model supports that pediatric providers must take responsibility for initiating transition discussions early in adolescence and preparing patients through transition processes and that adult providers must take responsibility for accepting those patients.…”

“…Written forms of communication such as summaries or TOC plans can be effective when verbal handoffs are not feasible. Effective use of the electronic health record (EHR), such as order sets and standardized clinic templates, can create consistency in the documentation of adolescent and young adult visits and has been shown to improve communication among health care teams, patients, and caregivers (Hsu et al, 2005; Pamplin et al, 2019; Rosen et al, 2011).…”

Procedural Telementoring in Rural, Underdeveloped, and Austere Settings: Origins, Present Challenges, and Future Perspectives

“…With tremendous commitment to logistical issues, air superiority, and geographic stability, the military medical systems of developed nations such as the United States have recently provided technical and human resources to produce operational medical results equal to, or better than, those expected in mature civilian trauma systems (144,145). However, as envisioned, future military engagements are more likely to involve peer or near-peer adversaries, limiting freedom of movement, or to involve asymmetric small-group special forces actions conducted over vast and undeveloped areas (146,147). Such conditions may more dramatically reflect austere conditions with resource limitations such as caregiver numbers, knowledge, skill, or ability; diagnostic capabilities; equipment, supplies, or medication quantity, quality, or availability; or the ability to evacuate patients given the time or distance to definitive care (147).…”

“…However, as envisioned, future military engagements are more likely to involve peer or near-peer adversaries, limiting freedom of movement, or to involve asymmetric small-group special forces actions conducted over vast and undeveloped areas (146,147). Such conditions may more dramatically reflect austere conditions with resource limitations such as caregiver numbers, knowledge, skill, or ability; diagnostic capabilities; equipment, supplies, or medication quantity, quality, or availability; or the ability to evacuate patients given the time or distance to definitive care (147). Pamplin and colleagues (147) have also emphasized that rescuing personnel from potentially preventable deaths in such environments may involve pushing advanced management capabilities to frontline providers, as these authors predict that traditional echelons of care will become compressed or eliminated and that the necessary lifesaving care will be provided at the point of need.…”

Methods used to examine technology in relation to the quality of nursing work in acute care: A systematic integrative review

“…Health care in acute hospitals is undergoing transformational change as new technologies are implemented. Integration of new technologies offers numerous potential benefits to nurses through facilitated decision‐making (Bhandari, Hassanein, & Deaves, ; Pamplin et al, ; Radecki & Medow, ) and enhanced patient safety and quality outcomes (Kutney‐Lee & Kelly, ). However, international experiences suggest nurses have concerns about how health information technologies impact their complex day‐to‐day work (Berg, LoCurto, & Lippoldt, ; Bergey, Goldsack, & Robinson, ), as some technologies have failed to deliver solutions that support the “real world” of nurses' work practices (Bergey et al, ; Topaz et al, ).…”