Professional and interprofessional differences in electronic health records use and recognition of safety issues in critically ill patients

Abstract

During interprofessional intensive care unit (ICU) rounds each member of the interprofessional team is responsible for gathering and interpreting information from the electronic health records (EHR) to facilitate effective team decision-making. This study was conducted to determine how each professional group reviews EHR data in preparation for rounds and their ability to identify patient safety issues. Twenty-five physicians, 29 nurses, and 20 pharmacists participated. Individual participants were given verbal and written sign-out and then asked to review a simulated record in our institution's EHR, which contained 14 patient safety items. After reviewing the chart, subjects presented the patient and the number of safety items recognised was recorded. About 40%, 30%, and 26% of safety issues were recognised by physicians, nurses, and pharmacists, respectively (p = 0.0006) and no item recognised 100% of the time. There was little overlap between the three groups with only 50% of items predicted to be recognised 100% of the time by the team. Differential recognition was associated with marked differences in EHR use, with only 3/152 EHR screens utilised by all three groups and the majority of screens used exclusively only by one group. There were significant and non-overlapping differences in individual profession recognition of patient safety issues in the EHR. Preferential identification of safety issues by certain professional groups may be attributed to differences in EHR use. Future studies will be needed to determine if shared decision-making during rounds can improve recognition of safety issues.

Keywords: Communication; interprofessional collaboration; interprofessional practice; quantitative method; simulation; team effectiveness.

Figure 1

Differences in recognition of the safety issues by each professional group. Twenty-five physicians (red), 20 pharmacists (blue), and 29 nurses (green) underwent electronic health record simulation. Each item in the case is represented by a “spoke” in the plot and the recognition rate represented by the concentric rings. *Highest recognition by a professional group compared with remaining two groups combined was significant (p = 0.039).

Figure 2

Total and unique screen utilisation by professional teams. Twenty-five physicians, 20 pharmacists, and 29 nurses underwent electronic health record simulation and total number of screens (left panel) and number of unique screens (right panel) was measured. There were no statistically significant differences between the three groups in either total or unique screens visited (p > 0.05).

Figure 3

Relationship between screen use and performance. Recognition of safety issues correlated with the number of unique screens visited for physicians (r = 0.46, left panel). Recognition of safety issues correlated with unique/total screens visited for pharmacists (r = −0.6, right panel). There was no association between screen utilisation and performance (not shown).

Figure 4

Similarities and differences in the top 10 unique screens visited by each professional group. Total 152 unique screens were visited by the cohort. Only 3 of the top 10 screens were used by all 3 professional groups.

Figure 5

Differences in time spent on screen types. The 152 unique screens visited by the cohort of physicians (red), pharmacist (blue), and nurses (green) were classified into 10 macro-categories. Six of the 10 macro-categories account for 95% of the time used in the simulation and are represented by a “spoke.” Non-lab tests, non-electronic health record programmes, input/output, and vitals screens account for less than 5% of time and are not included in the figure.

Figure 6

Pattern of screen use classified by macro-categories. Each row represents a participant and each colour represents one of 10 screen macro-categories. The width of a bar represents the time spent on a screen category. Pattern of electronic health record use varies between and within professions.