Use of a Novel, Electronic Health Record–Centered, Interprofessional ICU Rounding Simulation to Understand Latent Safety Issues

Objectives: The electronic health record is a primary source of information for all professional groups participating in ICU rounds. We previously demonstrated that, individually, all professional groups involved in rounds have significant blind spots in recognition of patient safety issues in the electronic health record. However, it is unclear how team dynamics impacts identification and verbalization of viewed data. Therefore, we created an ICU rounding simulation to assess how the interprofessional team recognized and reported data and its impact on decision-making. Design: Each member of the ICU team reviewed a simulated ICU chart in the electronic health record which contained embedded patient safety issues. The team conducted simulated rounds according to the ICU's existing rounding script and was assessed for recognition of safety issues. Setting: Academic medical center. Subjects: ICU residents, nurses, and pharmacists. Intervention: None. Measurements and Main Results: Twenty-eight teams recognized 68.6% of safety issues with only 50% teams having the primary diagnosis in their differential. Individually, interns, nurses, and pharmacists recognized 30.4%, 15.6%, and 19.6% of safety items, respectively. However, there was a negative correlation between the intern's performance and the nurse's or the pharmacist's performance within a given team. The wide variance in recognition of data resulted in wide variance in orders. Overall, there were 21.8 orders requested and 21.6 orders placed per case resulting in 3.6 order entry inconsistencies/case. Between the two cases, there were 145 distinct orders place with 43% being unique to a specific team and only 2% placed by all teams. Conclusions: Although significant blind spots exist in the interprofessional team's ability to recognize safety issues in the electronic health record, the inclusion of other professional groups does serve as a partial safety net to improve recognition. Electronic health record–based, ICU rounding simulations can serve as a test-bed for innovations in ICU rounding structure and data collection. This work was performed at Oregon Health and Science University, Portland, OR. Supported, in part, by Agency for Healthcare Research and Quality R01HS023793. Drs. Bordley's, McGrath's, Nguyen's, and Gold's institutions received funding from the Agency for Healthcare Research and Quality (AHRQ) and American Association of Medical Colleges (AAMC) and Donaghue Foundation. Drs. Bordley and McGrath received support for article research from the AHRQ and AAMC. Drs. Mulanax's and Mohan's institutions received funding from AAMC and AHRQ r01HS23793. Dr. Gold received support for article research from the National Institutes of Health. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: goldje@ohsu.edu Copyright © by 2018 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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