Abstract
Objectives Selecting appropriate respiratory support in critical care is complex, and some decisions
require information that may be unknown when the treatment assignment is necessary.
Digital technologies such as electronic health records (EHR) are essential components
in critical care medicine to support respiratory support care delivery and management
of patients with respiratory failure. However, there are limited studies on EHR use
that enable clinical decisions related to respiratory support. The objective of this
study is to understand how clinicians use EHRs for their decision-making related to
respiratory support in intensive care units (ICUs).
Methods Using a socio-technical systems approach, we conducted nine observations with nine
different care teams for 35 hours at two ICUs within a large academic hospital system.
We created a journey map to illustrate clinicians' respiratory support decision-making
processes. We identified barriers related to decision-making processes within the
ICU socio-technical work context and characterized them based on macro-cognitive functions
to derive themes that can capture the decision-making patterns associated with EHR
use.
Results Our analysis identified three overarching themes that represent clinicians' use of
EHR for their respiratory support decisions: (1) fragmented information and tasks
for individual sensemaking; (2) EHR workarounds for collaborative decision-making;
and (3) interruptive order entry and order execution. These three themes represent
three major sequential stages (i.e., before, during, and after morning rounds) related
to clinicians' respiratory support decision-making processes, and their interaction
with EHR significantly varies between stages.
Conclusion Our findings reflected different EHR use patterns before, during, and after morning
rounds for decision-making related to respiratory support. These findings indicated
potential opportunities for diagnostic clinical decision support (CDS) to facilitate
respiratory support decisions.
Keywords
electronic health record - critical care - respiratory support - clinical decision
support - qualitative study
