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Reporting Outcomes of Pediatric Intensive Care Unit Patients to Referring Physicians via an Electronic Health Record-Based Feedback SystemFunding The use of REDCap in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH; grant number: UL1TR002537). C.L.C. is supported by the Agency for Healthcare Research and Quality (AHRQ) through a K08 grant (HS026965) and an internal start-up grant from the University of Iowa Carver College of Medicine Department of Pediatrics. H.S. is partially supported by the AHRQ (R01HS27363) and Department of Veterans Affairs (VA) Health Services Research and Development Service Center for Innovations in Quality, Effectiveness and Safety (grant number: CIN 13–413). H.S.R. is supported by an NIH Clinical and Translational Science Award (award number: UL1TR002537) through the University of Iowa's Institute for Clinical and Translational Science. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH, AHRQ, or the Department of Veterans Affairs.
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.
Keywordsaudit and feedback - electronic health records and systems - care transition - provider-provider communication - pediatrics
Protection of Human and Animal Subjects
This project was performed in compliance with the World Medical Association Declaration of Helsinki on ethical principles for medical research involving human subjects. It was reviewed and determined to be exempt from human subjects research oversight by the University of Iowa Institutional Review Board.
Received: 20 December 2021
Accepted: 14 March 2022
11 May 2022 (online)
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