Nolan Matthew E, Cartin-Ceba Rodrigo, Moreno-Franco Pablo, Pickering Brian, Herasevich Vitaly
Division of Pulmonary and Critical Care, Mayo Clinic, Rochester, Minnesota, United States.
Department of Critical Care Medicine, Mayo Clinic, Scottsdale, Arizona, United States.
Appl Clin Inform. 2017 Oct;8(4):1197-1207. doi: 10.4338/ACI-2017-04-RA-0060. Epub 2017 Dec 22.
The electronic chart review habits of intensive care unit (ICU) clinicians admitting new patients are largely unknown but necessary to inform the design of existing and future critical care information systems.
We conducted a survey study to assess the electronic chart review practices, information needs, workflow, and data display preferences among medical ICU clinicians admitting new patients. We surveyed rotating residents, critical care fellows, advanced practice providers, and attending physicians at three Mayo Clinic sites (Minnesota, Florida, and Arizona) via email with a single follow-up reminder message.
Of 234 clinicians invited, 156 completed the full survey (67% response rate). Ninety-two percent of medical ICU clinicians performed electronic chart review for the majority of new patients. Clinicians estimated spending a median (interquartile range (IQR)) of 15 (10-20) minutes for a typical case, and 25 (15-40) minutes for complex cases, with no difference across training levels. Chart review spans 3 or more years for two-thirds of clinicians, with the most relevant categories being imaging, laboratory studies, diagnostic studies, microbiology reports, and clinical notes, although most time is spent reviewing notes. Most clinicians (77%) worry about overlooking important information due to the volume of data (74%) and inadequate display/organization (63%). Potential solutions are chronologic ordering of disparate data types, color coding, and explicit data filtering techniques. The ability to dynamically customize information display for different users and varying clinical scenarios is paramount.
Electronic chart review of historical data is an important, prevalent, and potentially time-consuming activity among medical ICU clinicians who would benefit from improved information display systems.
重症监护病房（ICU）接收新患者的临床医生的电子病历审查习惯在很大程度上尚不明确，但对于现有和未来重症监护信息系统的设计而言是必要的。
我们开展了一项调查研究，以评估接收新患者的医学ICU临床医生的电子病历审查实践、信息需求、工作流程以及数据显示偏好。我们通过电子邮件对梅奥诊所三个院区（明尼苏达州、佛罗里达州和亚利桑那州）的轮转住院医师、重症监护专科住院医师、高级执业提供者以及主治医生进行了调查，并发送了一条跟进提醒信息。
在邀请的234名临床医生中，156名完成了完整调查（回复率67%）。92%的医学ICU临床医生对大多数新患者进行电子病历审查。临床医生估计，对于典型病例，审查时间中位数（四分位间距（IQR））为15（10 - 20）分钟，对于复杂病例为25（15 - 40）分钟，不同培训水平的医生之间无差异。三分之二的临床医生审查病历的时间跨度为3年或更长时间，最相关的类别是影像学、实验室检查、诊断性检查、微生物学报告和临床记录，不过大部分时间花在审查记录上。大多数临床医生（77%）担心由于数据量（74%）以及显示/组织方式不足（63%）而忽略重要信息。潜在的解决方案包括对不同数据类型进行时间顺序排序、颜色编码以及明确的数据过滤技术。为不同用户和不同临床场景动态定制信息显示的能力至关重要。
对于医学ICU临床医生而言，对历史数据进行电子病历审查是一项重要、普遍且可能耗时的活动，他们将从改进的信息显示系统中受益。
