Physician Perceptions of the Electronic Problem List in Pediatric Trauma Care
Bat-Zion Hose1,2, Peter L T Hoonakker2, Abigail R Wooldridge3
1Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, United States.
Insights
Physicians desire electronic problem lists (PL) in pediatric trauma care to be more than a diagnosis list. Optimal PL design is needed for quick access to critical patient information during emergencies.
Area of Science:
- Medical Informatics
- Pediatric Trauma Care
- Clinical Documentation
Background:
- The electronic problem list (PL) is a critical component of patient records.
- Understanding physician perceptions of the PL in pediatric trauma is essential for optimizing its utility.
- Current PLs may not fully meet the needs of high-acuity settings like pediatric trauma.
Purpose of the Study:
- To explore physician perceptions regarding the goals, characteristics, and content of electronic problem lists in pediatric trauma care.
- To identify desired functionalities and information elements for an effective pediatric trauma electronic problem list.
Main Methods:
- Conducted 12 semistructured interviews with physicians across emergency medicine, surgery, anesthesia, and pediatric critical care services.
- Employed qualitative content analysis to identify themes related to PL goals, characteristics, and content.
- Reviewed the hospital's PL etiquette document for guideline insights.
Main Results:
- Identified five key goals for the PL: problem documentation, sense-making, care planning, care team awareness, and communication.
- Determined seven desired characteristics: completeness, efficiency, accessibility, multi-user support, organization, pre-arrival creation, and representation of uncertainty.
- Cataloged 22 essential patient-related information elements, including injuries and vital signs.
- Observed variations in physician-suggested criteria across different services.
Conclusions:
- Physicians envision the electronic PL as a dynamic tool beyond a static diagnosis list in pediatric trauma.
- Essential information elements are often dispersed across the electronic health record, highlighting a need for improved PL integration.
- Further research is required to develop and evaluate optimal electronic PL designs for emergent pediatric trauma cases, ensuring timely access to critical patient data.
Objective:
To describe physician perceptions of the potential goals, characteristics, and content of the electronic problem list (PL) in pediatric trauma.
Methods:
We conducted 12 semistructured interviews with physicians involved in the pediatric trauma care process, including residents, fellows, and attendings from four services: emergency medicine, surgery, anesthesia, and pediatric critical care. Using qualitative content analysis, we identified PL goals, characteristics, and patient-related information from these interviews and the hospital's PL etiquette document of guideline.
Results:
We identified five goals of the PL (to document the patient's problems, to make sense of the patient's problems, to make decisions about the care plan, to know who is involved in the patient's care, and to communicate with others), seven characteristics of the PL (completeness, efficiency, accessibility, multiple users, organized, created before arrival, and representing uncertainty), and 22 patient-related information elements (e.g., injuries, vitals). Physicians' suggested criteria for a PL varied across services with respect to goals, characteristics, and patient-related information.
Conclusion:
Physicians involved in pediatric trauma care described the electronic PL as ideally more than a list of a patient's medical diagnoses and injuries. The information elements mentioned are typically found in other parts of the patient's electronic record besides the PL, such as past medical history and labs. Future work is needed to evaluate the optimal design of the PL so that users with emergent cases, such as pediatric trauma, have access to key information related to the patient's immediate problems.
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