Model development for EHR interdisciplinary information exchange of ICU common goals

Area of Science:

• Healthcare Informatics
• Clinical Communication
• Patient Safety

Background:

• Effective interdisciplinary patient information exchange is crucial for safe, efficient, and patient-centered intensive care unit (ICU) care.
• Challenges in ICUs include frequent patient handoffs, high patient acuity, and vast data, complicating information exchange.
• Verbal communication is limited by interruptions and time constraints, leading ICUs to rely on electronic health records (EHRs) to minimize errors and information loss.

Purpose of the Study:

• To develop a model for interdisciplinary information exchange of common goals within the ICU using EHRs.
• To identify how EHRs can better support collaborative decision-making and communication in critical care settings.

Main Methods:

• Integration of distributed cognition and clinical communication space theoretical frameworks.
• Observation of 59.5 hours of interdisciplinary rounds in a neurovascular ICU.
• Conducting five interviews and one focus group with ICU nurses and physicians.

Main Results:

• Current ICU EHR documentation tools are insufficient for capturing collaborative decision-making and goal-directed communication between nurses and physicians.
• Clinicians find EHRs inefficient for information retrieval, reinforcing a reliance on verbal communication.
• Existing EHR functionalities do not adequately support the explicit documentation of goals, interventions, and assessments.

Conclusions:

• EHRs should incorporate tools for explicit documentation of goals, interventions, and assessments, with synthesized information outputs.
• EHRs need messaging tools to facilitate collaborative decision-making and safety checks currently performed verbally.
• Enhancements to EHRs can improve interdisciplinary communication and patient safety in the ICU.