Intensive care units (ICU) comprise the highest resource utilization area in a hospital. One hallmark of ICUs is their high degree of data density, with nearly 1800 data points/patient/day. Managing this data density is essential for the delivery of safe and efficient care. Interprofessional (IP) rounds are an essential tool that can improve communication and reduce errors within the ICU. However, a major barrier to conducting effective IP rounds is efficient and accurate gathering of information, specifically through EHRs. This is exacerbated by the observation that each profession has different workflows in respect to the EHR and thus has access to different data for each patient. Our preliminary data suggest that 40% of laboratory values are miscommunicated by physicians during ICU rounds with only 6% of these errors recognized. The content of the data on the EHR generated rounding tool greatly influenced the likelihood of communication errors occurring, yet there was still wide variability in the content and structure of the individual rounding tool employed. Of even greater concern, these data only represent 1 data domain and 1 professional group. We hypothesize that a large number of data communication errors exist across all data domains and for all professional groups in IP ICU rounds. By using a multimodal approach and a series of toolboxes to standardize and optimize data retrieval from the EHR, we can ensure accurate and effective data communication during rounds and reduce the incidence of these data communication errors.
In Aim #1 we will perform a comprehensive audit of ICU rounds to determine the data domains at greatest risk for communication errors, and the role the EHR and clinical users play in the genesis of these errors. We will also conduct a national survey to determine which data domains should be examined and how data should be communicated between ICU IP rounding team members. These data will be used to create a series of high complexity use cases for an EHR centered IP ICU rounds simulation in Aim #2. These simulations will recreate currently existing data communication errors and establish baseline usability metrics by incorporating eye and screen tracking to study and analyze team member interaction with the EHR before and during rounds.
In Aim #3, we will use data from Aims #1 and #2 to create a series of toolboxes to facilitate the creation of EHR generated rounding tools, either for standard IP ICU rounds or a series of screens for an EHR-centric ICU rounding structure that allows for synchronous, real-time viewing of data by all members of the IP team. These toolboxes will be tested in our simulation environment to ensure their ability to improve the veracity of communicated data without having negative unintended consequences on team communication, workflow efficiency or EHR usability. By the end of the funding period we will have developed a series of standards to effectively employ the EHR to ensure adequate and accurate data communication for all members of the IP team during ICU rounds. The methodology refined in this protocol will allow for rapid testing in other care environments and for rapid assessment and deployment across the healthcare enterprise.
A vast amount of information must be collected and effectively communicated during interprofessional ICU rounds to allow effective clinical decision making. The Electronic Health Record (EHR) is at the nexus of this issue as the source of clinical data and the device utilized to generate tools for reporting it. This application will see to define the full extent to which clinical data are miscommunicated on rounds and through the use of a controlled ICU rounds simulation, develop a series of toolboxes to ensure accurate data reporting during, and effective integration of the EHR into, interprofessional ICU rounds.
