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

Abstract

Objective-The Electronic Health Record (EHR) is a primary source of information for all professional groups participating in ICU rounds. We previously demonstrated that, individually, all professional groups involved in rounds have significant blind spots in recognition of patient safety issues in the EHR. However, it is unclear how team dynamics impacts identification and verbalization of viewed data. Therefore, we created an ICU rounding simulation to assess how the interprofessional team recognized and reported data and its impact on decision making. Design-Each member of the ICU team reviewed a simulated ICU chart in the EHR which contained embedded patient safety issues. The team conducted simulated rounds according to the ICU's existing rounding script and was assessed for recognition of safety issues. Setting-Academic Medical Center Subjects-ICU residents, nurses and pharmacists Intervention-none Measurements and Main Results-28 teams recognized 68.6% of safety issues with only 50% teams having the primary diagnosis in their differential. Individually, interns, nurses and pharmacists recognized 30.4%, 15.6% and 19.6% of safety items respectively. However, there was For information regarding this article,

Data Omission by Physician Trainees on ICU Rounds*

“…3; and Supplementary Fig. 3, Supplemental Digital Content 1, http://links.lww.com/CCM/E198), that vital sign instability (32) and important physiologic trends (33) are routinely omitted during studies of physician hand-off communication and that physician trainees overlooked 60–70% of safety issues during EHR review of simulated ICU patients (34, 35) all argue that ICU teams should not blindly accept trainee decisions in regard to data selectivity. Adding further complexity, attendings may differ by data completeness preferences and relevant data vary by patient diagnoses for which there currently is no widely accepted standard.…”

Nursing workload associated with the frequency of multidisciplinary rounds: a cross-sectional study

“…Multidisciplinary rounds are essential to the care of critically ill patients because professionals from diverse disciplines have varied perceptions and recognize different aspects of medical problems. ( 10 , 11 ) Multidisciplinary rounds are associated with positive outcomes for both patients ( 1 , 2 , 5 ) and interprofessional teams because they increase collaboration and understanding of daily goals, ( 12 ) facilitate the sharing of both similar and complementary insights, ( 16 ) enable consensus-based decision making, and reduce conflicts within teams. ( 7 ) The fact that multidisciplinary rounds were not conducted in greater than one-third of scheduled days is cause for concern.…”

“…However, 20 - 30% of intensive care units (ICUs) surveyed in numerous studies do not perform multidisciplinary rounds. ( 8 , 9 ) Given that professionals from diverse disciplinary backgrounds bring alternative perspectives that can lead to vastly different conclusions regarding specific aspects of patient care, ( 10 , 11 ) multidisciplinary collaboration should be encouraged. In addition, communication failures may cause adverse events and prolong ICU lengths of stay.…”

The Impact of Electronic Health Record–Based Simulation During Intern Boot Camp: Interventional Study

“…This includes having the appropriate density and quality of data, the ability to house charts in the same system used clinically, to maintain user and system customizations, and to shift charts temporally so that data are current and thus, consistent with the day of activity [24][25][26]. Our group has previously developed high-fidelity simulated patient cases to assess safe and effective EHR use [13,15,27,28]. Participation in EHR-based simulation improved recognition of embedded patient safety issue recognition upon repeat simulation testing [27].…”