Clinician preferences for verbal communication compared to EHR documentation in the ICU

Summary

Background: Effective communication is essential to safe and efficient patient care. Additionally, many health information technology (HIT) developments, innovations, and standards aim to implement processes to improve data quality and integrity of electronic health records (EHR) for the purpose of clinical information exchange and communication.

Objective: We aimed to understand the current patterns and perceptions of communication of common goals in the ICU using the distributed cognition and clinical communication space theoretical frameworks.

Methods: We conducted a focus group and 5 interviews with ICU clinicians and observed 59.5 hours of interdisciplinary ICU morning rounds.

Results: Clinicians used an EHR system, which included electronic documentation and computerized provider order entry (CPOE), and paper artifacts for documentation; yet, preferred the verbal communication space as a method of information exchange because they perceived that the documentation was often not updated or efficient for information retrieval. These perceptions that the EHR is a “shift behind” may lead to a further reliance on verbal information exchange, which is a valuable clinical communication activity, yet, is subject to information loss.

Conclusions: Electronic documentation tools that, in real time, capture information that is currently verbally communicated may increase the effectiveness of communication.

Keywords

ICU - communication - interdisciplinary - electronic health record

• References

• 1 Fagin CM. Collaboration between nurses and physicians: no longer a choice. Acad Med 1992; 67: 295-303.
• 2 Larson E. The impact of physician-nurse interaction on patient care. Holist Nurs Pract 1999; 13: 38-46.
• 3 Sexton JB, Thomas EJ, Helmreich RL. Error, stress, and teamwork in medicine and aviation: cross sectional surveys. BMJ 2000; 320: 745-749.
• 4 Zwarenstein M, Reeves S. Working together but apart: barriers and routes to nurse –physician collaboration. Jt Comm J Qual Improv 2002; 28: 242-7. 209.
• 5 Pronovost P, Wu A, Sexton J. Acute decompensation after removing a central line: practical approaches to increasing safety in the intensive care unit. Ann Intern Med 2004; 140: 1025-1033.
• 6 Centers for Medicare and Medicaid Services.. Electronic Health Record Incentive Program. In. Baltimore, MD 2010
• 7 Sentinel event alert.. Available at http://www.jointcommission.org/SentinelEvents/SentinelEventAlert
• 8 Stein-Parbury J, Liaschenko J. Understanding collaboration between nurses and physicians as knowledge at work. Am J Crit Care 2007; 16: 470-477 quiz 478.
• 9 Patel VL, Zhang J, Yoskowitz NA, Green R, Sayan OR. Translational cognition for decision support in critical care environments: a review. J Biomed Inform 2008; 41: 413-431.
• 10 Strople B, Ottani P. Can technology improve intershift report? What the research reveals. J Prof Nurs 2006; 22: 197-204.
• 11 Arora V, Johnson J, Lovinger D, Humphrey HJ, Meltzer DO. Communication failures in patient sign-out and suggestions for improvement: a critical incident analysis. Qual Saf Health Care 2005; 14: 401-407.
• 12 Hutchins E. Cognition in the Wild. Cambridge, MA: MIT Press; 1995
• 13 Coiera E. When conversation is better than computation. J Am Med Inform Assoc 2000; 7: 277-286.
• 14 Hutchins E. How a cockpit remembers its speeds. Cognitive Science 1995; 19: 265-288.
• 15 Brown A. Distributed expertise in the classroom. In: Salomon G. editor. Distributed cognitions: Psychological and educational considerations. New York: Cambridge UP; 1993. p. 188-228.
• 16 Hazlehurst B, Gorman PN, McMullen CK. Distributed cognition: An alternative model of cognition for medical informatics. Int J Med Inform 2008; 77: 226-234.
• 17 Munir SK, Kay S. Organisational culture matters for system integration in health care. AMIA Annu Symp Proc 2003: 484-488.
• 18 Baggs JG, Schmitt MH. Nurses’ and Resident Physicians’ Perceptions of the Process of Collaboration in an MICU. Research in Nursing and Health 1997; 20: 71-80.
• 19 Collins S, Currie L. Interdisciplinary Collaboration in the ICU. Proceedings of the 10th International Congress on Nursing Informatics 2009; 146: 362-366.
• 20 Badjatia N. Fever control in the neuro-ICU: why, who, and when?. Curr Opin Crit Care 2009; 15: 79-82.
• 21 Van Eaton EG, Horvath KD, Lober WB, Rossini AJ, Pellegrini CA. A randomized, controlled trial evaluating the impact of a computerized rounding and sign-out system on continuity of care and resident work hours. J Am Coll Surg 2005; 200: 538-545.
• 22 Kim H, Harris MR, Savova GK, Chute CG. The first step toward data reuse: disambiguating concept representation of the locally developed ICU nursing flowsheets. Comput Inform Nurs 2008; 26: 282-289.
• 23 Collins SA, Currie LM, Bakken S, Cimino JJ. Information needs, Infobutton Manager use, and satisfaction by clinician type: a case study. J Am Med Inform Assoc 2009; 16: 140-142.
• 24 Hazlehurst B, McMullen C, Gorman P, Sittig D. How the ICU follows orders: care delivery as a complex activity system. AMIA Annu Symp Proc 2003: 284-288.
• 25 Collins S, Bakken S, Vawdrey D, Coiera E, Currie L. Model development for EHR interdisciplinary information exchange of ICU common goals. Int J Med Inform 2010 [epub ahead of print] available online 25. October 2010.