Variations in faculty assessment of NICU flowsheet data: implications for electronic data display

Understanding how physicians navigate through patient data to construct clinically meaningful information has implication for resident education as well as how patient data is displayed. The purpose of this study was to determine how physicians reason through patient data presented on a flowsheet in the neonatal intensive care unit (NICU).

A volunteer sample of 20 neonatologists took part in this study. Participants evaluated 5 hypothetical case scenarios presented on standardized NICU flowsheets to (1) select the best diagnosis for each case (diagnostic choice) and (2) identify the flowsheet items that most influenced their diagnostic choice (diagnostic reasoning).

Faculty had generally high agreement with respect to their diagnostic choices. There was little agreement on items that faculty considered clinically relevant for each case. On average, only 6% of items per case reached an agreement level of at least 75%.

We found that neonatologists who agreed on a diagnosis rarely agreed on the most important data elements that led them to that conclusion. Future studies designed to articulate how physicians decide to direct their attention when presented with flowsheet data may shed light on how this data is utilized and might be optimally presented.