Download PDF
CC BY 4.0 · ACI open 2025; 09(01): e9-e17
DOI: 10.1055/a-2521-2557
Research Article

How do Clinicians Use Electronic Health Records for Respiratory Support Decisions? A Qualitative Study in Critical Care

Tianyi Zhang
1   College of Engineering, University of Arizona, Tucson, Arizona, United States
,
Jarrod Mosier
2   College of Medicine- Tucson, University of Arizona, Tucson, Arizona, United States
,
Vignesh Subbian
1   College of Engineering, University of Arizona, Tucson, Arizona, United States
› Author Affiliations Financial Disclosures This research was funded, in part, by an Emergency Medicine Foundation grant sponsored by Fisher & Paykel and in part by the National Science Foundation under grant 1838745.
› Further Information
Also available at
   Permissions and Reprints

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

Protection of Human and Animal Subjects

This study was approved by the University of Arizona Institutional Review Board (Protocol #: 2011215104A001). All methods were performed in accordance with the relevant guidelines and regulations. All informed consent forms were distributed and received via REDCap.




Publication History

Received: 03 May 2024

Accepted: 09 January 2025

Article published online:
17 February 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany