Participation in EHR based simulation improves recognition of patient safety issues

Abstract

BackgroundElectronic health records (EHR) are becoming increasingly integrated into the clinical environment. With the rapid proliferation of EHRs, a number of studies document an increase in adverse patient safety issues due to the EHR-user interface. Because of these issues, greater attention has been placed on novel educational activities which incorporate use of the EHR. The ICU environment presents many challenges to integrating an EHR given the vast amounts of data recorded each day, which must be interpreted to deliver safe and effective care. We have used a novel EHR based simulation exercise to demonstrate that everyday users fail to recognize a majority of patient safety issues in the ICU. We now sought to determine whether participation in the simulation improves recognition of said issues.MethodsTwo ICU cases were created in our EHR simulation environment. Each case contained 14 safety issues, which differed in content but shared common themes. Residents were given 10 minutes to review a case followed by a presentation of management changes. Participants were given an immediate debriefing regarding missed issues and strategies for data gathering in the EHR. Repeated testing was performed in a cohort of subjects with the other case at least 1 week later.Results116 subjects have been enrolled with 25 subjects undergoing repeat testing. There was no difference between cases in recognition of patient safety issues (39.5% vs. 39.4%). Baseline performance for subjects who participated in repeat testing was no different than the cohort as a whole. For both cases, recognition of safety issues was significantly higher among repeat participants compared to first time participants. Further, individual performance improved from 39.9% to 63.6% (p = 0.0002), a result independent of the order in which the cases were employed. The degree of improvement was inversely related to baseline performance. Further, repeat participants demonstrated a higher rate of recognition of changes in vitals, misdosing of antibiotics and oversedation compared to first time participants.ConclusionParticipation in EHR simulation improves EHR use and identification of patient safety issues.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6920-14-224) contains supplementary material, which is available to authorized users.

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

“…This study highlights how poor physicians, nurses, and pharmacists are at identifying dangerous trends and safety issues in the EHR, confirming our prior work with physicians (Stephenson et al, 2014). When safety issues are recognised, professional groups tend to identify these safety issues in certain predictable domains.…”

“…Consequently, it is easy to envision how problems with data fragmentation and poor user interfaces can lead to significant issues with clinical cognition and pursuant errors. This was confirmed in our prior study, where residents and ICU fellows only recognised 40% of relevant patient safety issues in an EHRbased ICU simulation exercise (Stephenson, Gorsuch, Hersh, Mohan, & Gold, 2014). As cognitive factors are associated with up to 74% of diagnostic errors, the improvement of clinical cognition associated with the efficient extraction and synthesis of immense data from the EHR are critical in optimal patient care (Graber, Franklin, & Gordon, 2005;Roberson et al, 2014).…”

“…With reforms in medical education, there has been increasing emphasis on simulation training as it has been shown to increase knowledge and skills in invasive procedures as well as communication in a realistic environment (Wayne, Barsuk, O'Leary, Fudala, & McGaghie, 2008;Wayne, Didwania et al, 2008;Zendejas, Brydges, Wang, & Cook, 2013). Prior studies in EHR simulation have suggested EHR simulation promotes quality patient care as well as improvement in the identification of patient safety issues in critically ill patients (Landman et al, 2014;Milano, Hardman, Plesiu, Rdesinski, & Biagioli, 2014;Stephenson et al, 2014).…”

“…One of our previously validated cases which we employed in this study is a 74-year-old woman who is admitted with septic shock, acute renal failure, and acute respiratory distress syndrome. A total of 14 safety issues were built into the case and were categorised into 3 groups: (1) dangerous trends in the patient's condition, (2) medication errors, and (3) failure to adhere to critical care best practices (March et al, 2013;Stephenson et al, 2014). The goal of this study was to utilise a high-fidelity EHR-based simulation to understand the workflow of the different members of the interprofessional ICU rounding team and the ability of team members from each professional group to recognise safety issues in a critically ill patient.…”

Use of Electronic Health Record Simulation to Understand the Accuracy of Intern Progress Notes

“…8,9 In this article, we describe the creation of an EHR simulation exercise based on progress notes as part of an intern learning week, as well as the lessons learned with respect to intern EHR use patterns.…”