Electronic Health Record Solutions for Accurate Reporting of Data on Interprofessional Intensive Care Unit Rounds

Intensive Care Units (ICUs) generate significant amounts of patient data, largely generated by continuous electronic monitoring of patients. Numerous professional groups care for patients in the ICU, each having different electronic health record (EHR) workflows and different views into the record, effectively creating data silos based on the type of care they provide. The implementation of interprofessional (IP) rounds–that include participation by the entire care team--improves communication and reduces errors. One major barrier to effective IP rounds is the ability to collect information efficiently and accurately through the EHR. This research identified the data domains at greatest risk for communication errors during ICU rounds and the role that the EHR and clinical users have in the genesis of these errors. The research was conducted with a comprehensive real-world audit of ICU rounds, a national survey of communication needs, and the creation and use of simulated ICU rounds.

The specific aims of the research were:

• Determine frequency of and the factors responsible for data communication errors during IP ICU rounds.
• Establish the infrastructure and protocol for an IP ICU rounds simulation.
• Develop and test standardized methods for IP data collection and presentation for ICU Rounds.

Less than 30 percent of providers from the survey felt that data is accurately presented on ICU rounds, substantiated by the finding from the ICU audit and simulations that a high frequency of lab data was omitted from rounds with resultant communication errors. Physicians, nurses, and pharmacists participated in the simulated ICU rounds. Only three of 152 EHR views were used by all three groups, with the vast majority of EHR views used exclusively by only one group. The result was the creation of blind spots of patient data for end users, even of clinically important data. In the use of rounding artifacts–paper or electronic summaries of patient data used for rounds–the automatic population of data resulted in more complete and accurate data in the artifact. However, there were more omissions during verbal reports of the data that was autopopulated versus manually notated by the end user, highlighting that how data are collected has an impact on cognitive processing.

The researchers concluded that the future of rounds will rely on eliminating the intermediate step of full data gathering and will need to move to the use of real-time simultaneous reviewing of data by all members of the IP team. This approach will facilitate distributive cognition and shared decision making but will require new hardware and software solutions for data visualization allowing for a standard approach spanning across the IP teams. The use of simulated ICU rounds are valuable for both research and for training purposes.