Physician Attitudes about patient-facing information displays at an urban emergency department (original) (raw)
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Applied Clinical Informatics, 2019
Background Hospital emergency departments (EDs) are dynamic environments, involving coordination and shared decision making by staff who care for multiple patients simultaneously. While computerized information systems have been widely adopted in such clinical environments, serious issues have been raised related to their usability and effectiveness. In particular, there is a need to support clinicians to communicate and maintain awareness of a patient's health status, and progress through the ED plan of care. Objective This study used work-centered usability methods to evaluate an integrated patient-focused status display designed to support ED clinicians' communication and situation awareness regarding a patient's health status and progress through their ED plan of care. The display design was informed by previous studies we conducted examining the information and cognitive support requirements of ED providers and nurses. Methods ED nurse and provider participants were...
2012
Study objective: We identify and describe emergency physicians' and nurses' perceptions of the effect of an integrated emergency department (ED) information system on the quality of care delivered in the ED. Methods: A qualitative study was conducted in 4 urban EDs, with each site using the same ED information system. Participants (nϭ97) were physicians and nurses with data collected by 69 detailed interviews, 5 focus groups (28 participants), and 26 hours of structured observations. Results: Results revealed new perspectives on how an integrated ED information system was perceived to affect incentives for use, awareness of colleagues' activities, and workflow. A key incentive was related to the positive effect of the ED information system on clinical decisionmaking because of improved and quicker access to patient-specific and knowledge-base information compared with the previous stand-alone ED information system. Synchronous access to patient data was perceived to lead to enhanced awareness by individual physicians and nurses of what others were doing within and outside the ED, which participants claimed contributed to improved care coordination, communication, clinical documentation, and the consultation process. There was difficulty incorporating the use of the ED information system with clinicians' work, particularly in relation to increased task complexity; duplicate documentation, and computer issues related to system usability, hardware, and individuals' computer skills and knowledge. Conclusion: Physicians and nurses perceived that the integrated ED information system contributed to improvements in the delivery of patient care, enabling faster and better-informed decisionmaking and specialty consultations. The challenge of electronic clinical documentation and balancing data entry demands with system benefits necessitates that new methods of data capture, suited to busy clinical environments, be developed.
Analysis of user behavior in accessing electronic medical record systems in emergency departments
AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, 2010
Electronic patient tracking and records systems in emergency departments often connect to hospital information systems, ambulatory patient records and ancillary systems. The networked systems may not be fully interoperable and clinicians need to access data through different interfaces. This study was conducted to describe the interactive behavior of clinicians working with partially interoperable clinical information systems. We performed 78 hours of observation at two emergency departments, shadowing five physicians, ten nurses and four administrative staff. Actions related to viewing or recording data in any system or on paper were recorded. Collected data were compared along clinical roles and contrasted with findings across the two hospital sites. The findings suggest that differences in the levels of interoperability may affect the ways physicians and nurses interact with the systems. When tradeoffs in functionality are necessary for connecting ancillary systems, the effects o...
Implementation of an Emergency Department Computer System: Design Features That Users Value
Journal of Emergency Medicine, 2010
BackgroundElectronic medical records (EMRs) can potentially improve the efficiency and effectiveness of patient care, especially in the emergency department (ED) setting. Multiple barriers to implementation of EMR have been described. One important barrier is physician resistance. The “ED Dashboard” is an EMR developed in a busy tertiary care hospital ED. Its implementation was exceptionally smooth and successful.
Use of Electronic Health Record Documentation by Healthcare Workers in an Acute Care Hospital System
Journal of Healthcare Management, 2014
Acute care clinicians spend significant time documenting patient care information in electronic health records (EHRs). The documentation is required for many reasons, the most important being to ensure continuity of care. This study examined what information is used by clinicians, how this information is used for patient care, and the amount of time clinicians perceive they review and document information in the EHR. A survey administered at a large, multisite healthcare system was used to gather this information. Findings show that diagnostic results and physician documents are viewed more often than documentation by nurses and ancillary caregivers. Most clinicians use the information in the EHR to understand the patient's overall condition, make clinical decisions, and communicate with other caregivers. The majority of respondents reported they spend 1 to 2 hours per day reviewing information and 2 to 4 hours documenting in the EHR. Bedside nurses spend 4 hours per day documenting, with much of this time spent completing detailed forms seldom viewed by others. Various flow sheets and forms within the EHR are rarely viewed. Organizations should provide ongoing education and awareness training for hospital clinical staff on available forms and best practices for effective and efficient documentation. New forms and input fields should be added sparingly and in collaboration with informatics staff and clinical team members to determine the most useful information when developing documentation systems.
Assessment of Innovative Emergency Department Information Displays in a Clinical Simulation Center
Journal of cognitive engineering and decision making, 2015
The objective of this work was to assess the functional utility of new display concepts for an emergency department information system created using cognitive systems engineering methods, by comparing them to similar displays currently in use. The display concepts were compared to standard displays in a clinical simulation study during which nurse-physician teams performed simulated emergency department tasks. Questionnaires were used to assess the cognitive support provided by the displays, participants' level of situation awareness, and participants' workload during the simulated tasks. Participants rated the new displays significantly higher than the control displays in terms of cognitive support. There was no significant difference in workload scores between the display conditions. There was no main effect of display type on situation awareness, but there was a significant interaction; participants using the new displays showed improved situation awareness from the middl...
International Journal of …, 2010
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The entrance of the information technology within health organizations has been causing a true revolution, with new proposals in order to become a new practical facilitator on daily basis of health professionals. This article has the objective to evaluate the Electronic Patient Record (EPR) – ALERT EDIS – at a University Hospital. It has been evaluated a sample of 1,226 medical-cards from patients that have been served by 13 different medical specialties. In 95% of the medical cards there has been an insertion of a responsible and a 100% insertion of a diagnostics, and in only 0.32% there has been no anamnese nor external cause information (when applicable). In 9.54% of the medical cards there has been no evolution and in 31% the requested exams results were not described. Considering an overall, the EPR presents a good completeness from the majority of the evaluated items (-10% of absence). The EPR with compulsory field fulfillment is very valuable for its own quality with benefits to the patient assistance.
In support of emergency department health information technology
AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium
Emergency department visits represent a significant portion of medical care. Emergency physicians require immediate access to clinical information in order to provide quality care. Increased medical errors result when access to the complete medical record is limited. Clinicians' access to clinical information is limited to the greatest extent when care occurs over short time intervals, and between separate healthcare systems. Over the four-year period, the majority (85%) of all patients, stay within the same system; however, of patients with more than one visit, this percentage decreases to 66%. Of patients who return within 24 hours, 75% return to the same hospital or healthcare system. This patient population represents a unique cohort with special healthcare needs. Not only do they represent a disproportionate share of visits compared to those remaining within a single system but they also represent additional, and often underestimated, opportunities to provide quality care.