title: 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.
authors.affiliation: a Division of Pulmonary and Critical Care Medicine, Department of Medicine , Oregon Health & Science University , Portland , Oregon , USA.
authors.forename: Knewton K
authors.initials: KK
authors.lastname: Sakata
authors.affiliation: b Division of Pulmonary and Critical Care Medicine, Department of Medicine , University of Minnesota , Minneapolis , Minnesota , USA.
authors.forename: Laurel S
authors.initials: LS
authors.lastname: Stephenson
authors.affiliation: c Oregon Health & Science University Hospital , Portland , Oregon , USA.
authors.forename: Ashley
authors.initials: A
authors.lastname: Mulanax
authors.affiliation: d Department of Pharmacy Services and College of Pharmacy , Oregon Health & Science University , Portland , Oregon , USA.
authors.forename: Jesse
authors.initials: J
authors.lastname: Bierman
authors.affiliation: a Division of Pulmonary and Critical Care Medicine, Department of Medicine , Oregon Health & Science University , Portland , Oregon , USA.
authors.forename: Karess
authors.initials: K
authors.lastname: Mcgrath
authors.affiliation: a Division of Pulmonary and Critical Care Medicine, Department of Medicine , Oregon Health & Science University , Portland , Oregon , USA.
authors.forename: Gretchen
authors.initials: G
authors.lastname: Scholl
authors.affiliation: c Oregon Health & Science University Hospital , Portland , Oregon , USA.
authors.forename: Adrienne
authors.initials: A
authors.lastname: McDougal
authors.affiliation: d Department of Pharmacy Services and College of Pharmacy , Oregon Health & Science University , Portland , Oregon , USA.
authors.forename: David T
authors.initials: DT
authors.lastname: Bearden
authors.affiliation: e Department of Medical Informatics and Clinical Epidemiology , Oregon Health & Science University , Portland , Oregon , USA.
authors.forename: Vishnu
authors.initials: V
authors.lastname: Mohan
authors.affiliation: a Division of Pulmonary and Critical Care Medicine, Department of Medicine , Oregon Health & Science University , Portland , Oregon , USA.|e Department of Medical Informatics and Clinical Epidemiology , Oregon Health & Science University , Portland , Oregon , USA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Gold
mesh_terms: D001291:Attitude of Health Personnel; D016638:Critical Illness; D003430:Cross-Sectional Studies; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D006282:Health Personnel; D006801:Humans; D007362:Intensive Care Units; D033183:Interdisciplinary Communication; D061214:Patient Safety
keywords: Communication; interprofessional collaboration; interprofessional practice; quantitative method; simulation; team effectiveness