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A4293 - Use of an Interprofessional ICU Rounding Simulation to Understand EHR Use and Clinical Decision Making
Author Block: J. A. Gold1, J. Bordley2, K. K. Sakata3, G. Scholl1, A. McDougal1, J. Bierman1, V. Mohan4; 1Div of Pulm and Crit Care, OHSU, Portland, OR, United States, 2OHSU, Portland, OR, United States, 3Pulmonary Critical Care, The Vancouver Clinic, Vancouver, WA, United States, 4Medical Informatics, OHSU, Portland, OR, United States.
Background: The EHR is a primary source of information for all professional groups participating in daily ICU rounds. We previously demonstrated that all team members, irrespective of professional training, have significant, non-overlapping, blindspots in EHR utilization manifesting as an inability to recognize critical patient safety issues. However, these studies tested each member of the team individually and it is unclear to what extent team dynamics impacts verbalization of viewed data. Therefore, we created a high-fidelity ICU rounding simulation to test how the entire interprofessional team viewed and reported data and the impact this had on medical decision making. Methods: 2 ICU charts were created in our simulation instance of the EHR. Each case contained 5 days of ICU data including all relevant physiologic, respiratory, physician and nursing documentation. For each simulation, 1 ICU RN, Intern and pharmacist were given 10 min to review the chart to prepare for ICU rounds. For rounds, an additional ICU resident was recruited to serve as the order writer. A member of the team served as the attending. All simulations were done in situ. Each team was assessed for the number of safety issues caught and the orders entered into the system reviewed for accuracy and completeness. Results: 28 teams participated (18 case#1, 10 Case#2). Overall, teams recognized 68.6% of safety issues with a 3-fold variance between teams. Only 50% teams had the primary diagnosis in their differential. Individually, interns, RNs and pharmacists recognized 30.4%, 15.6% and 19.6% of safety items respectively. However, there was a strong, negative correlation between the intern’s performance and either the nurse’s or the pharmacist’s performance within a given team. The wide variance in recognition of data resulted in wide variance in orders. Overall, there were 21.8 ± 1.2 orders requested and 21.6 ± 1.3 orders placed per case resulting in 1.86 missed orders/case and 1.75 unrequested orders/case (3.38 mistakes/case). Between the 2 cases there were 142 distinct orders place with 41% being unique to a specific team and only 3.5%placed by all teams. Conclusions: We demonstrate that significant blindspots exist in the Interprofessional team’s ability to recognize safety issues in the EHR. The inclusion of other professional groups serves as a safety net for recognition of said issues. Overall, this manifests in wide variance in requested orders and thus care plans. We are now using the ICU rounding simulation to test innovations in ICU rounding structure and data collection.