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Reporting Outcomes of Pediatric Intensive Care Unit Patients to Referring Physicians via an Electronic Health
Christina L Cifra1, Cody R Tigges1, Sarah L Miller2
1Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States.
Insights
A new electronic health record system successfully provided timely pediatric intensive care unit (PICU) outcome feedback to emergency department (ED) physicians. This feasible and usable system is relevant for improving pediatric emergency care.
Area of Science:
- Health Informatics
- Clinical Systems Engineering
- Patient Safety
Background:
- Critically ill children often receive initial evaluation in front-line settings by clinicians with varied pediatric training.
- Effective communication of patient outcomes back to referring clinicians is crucial for learning but is inconsistently provided.
- Lack of timely feedback hinders performance improvement in pediatric emergency care.
Purpose of the Study:
- To determine the feasibility, usability, and clinical relevance of a semiautomated electronic health record (EHR)-supported system.
- To deliver timely and relevant pediatric intensive care unit (PICU) patient outcome feedback to referring emergency department (ED) physicians.
- To enhance the care transition process for critically ill children.
Main Methods:
- Iterative design and evaluation of a semiautomated EHR-supported feedback system.
- Utilized the Health Information Technology Safety Framework for system development.
- Conducted stakeholder interviews, focus groups, EHR log analysis, usability testing, and physician interviews over six months.
Main Results:
- The EHR-supported feedback process demonstrated feasibility with timely delivery and receipt of reports.
- Usability testing yielded excellent Systems Usability Scale scores, indicating ease of use.
- Physicians reported the system integrated well into workflows, added minimal workload, and was clinically relevant.
Conclusions:
- An EHR-supported system for delivering PICU outcome feedback to ED physicians is feasible, usable, and valued.
- The system shows potential for improving communication and learning in pediatric emergency care.
- Further research is needed to assess impact on clinical practice, patient outcomes, and applicability to other settings.
Background:
Many critically ill children are initially evaluated in front-line settings by clinicians with variable pediatric training before they are transferred to a pediatric intensive care unit (PICU). Because clinicians learn from past performance, communicating outcomes of patients back to front-line clinicians who provide pediatric emergency care could be valuable; however, referring clinicians do not consistently receive this important feedback.
Objectives:
Our aim was to determine the feasibility, usability, and clinical relevance of a semiautomated electronic health record (EHR)-supported system developed at a single institution to deliver timely and relevant PICU patient outcome feedback to referring emergency department (ED) physicians.
Methods:
Guided by the Health Information Technology Safety Framework, we iteratively designed, implemented, and evaluated a semiautomated electronic feedback system leveraging the EHR in one institution. After conducting interviews and focus groups with stakeholders to understand the PICU-ED health care work system, we designed the EHR-supported feedback system by translating stakeholder, organizational, and usability objectives into feedback process and report requirements. Over 6 months, we completed three cycles of implementation and evaluation, wherein we analyzed EHR access logs, reviewed feedback reports sent, performed usability testing, and conducted physician interviews to determine the system's feasibility, usability, and clinical relevance.
Results:
The EHR-supported feedback process is feasible with timely delivery and receipt of feedback reports. Usability testing revealed excellent Systems Usability Scale scores. According to physicians, the process was well-integrated into their clinical workflows and conferred minimal additional workload. Physicians also indicated that delivering and receiving consistent feedback was relevant to their clinical practice.
Conclusion:
An EHR-supported system to deliver timely and relevant PICU patient outcome feedback to referring ED physicians was feasible, usable, and important to physicians. Future work is needed to evaluate impact on clinical practice and patient outcomes and to investigate applicability to other clinical settings involved in similar care transitions.
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