Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States.
Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States.
Appl Clin Inform. 2022 Mar;13(2):495-503. doi: 10.1055/s-0042-1748147. Epub 2022 May 11.
Many critically ill children are initially evaluated in front-line settings by clinicians with variable pediatric training before they are transferred to a pediatric intensive care unit (PICU). Because clinicians learn from past performance, communicating outcomes of patients back to front-line clinicians who provide pediatric emergency care could be valuable; however, referring clinicians do not consistently receive this important feedback.
Our aim was to determine the feasibility, usability, and clinical relevance of a semiautomated electronic health record (EHR)-supported system developed at a single institution to deliver timely and relevant PICU patient outcome feedback to referring emergency department (ED) physicians.
Guided by the Health Information Technology Safety Framework, we iteratively designed, implemented, and evaluated a semiautomated electronic feedback system leveraging the EHR in one institution. After conducting interviews and focus groups with stakeholders to understand the PICU-ED health care work system, we designed the EHR-supported feedback system by translating stakeholder, organizational, and usability objectives into feedback process and report requirements. Over 6 months, we completed three cycles of implementation and evaluation, wherein we analyzed EHR access logs, reviewed feedback reports sent, performed usability testing, and conducted physician interviews to determine the system's feasibility, usability, and clinical relevance.
The EHR-supported feedback process is feasible with timely delivery and receipt of feedback reports. Usability testing revealed excellent Systems Usability Scale scores. According to physicians, the process was well-integrated into their clinical workflows and conferred minimal additional workload. Physicians also indicated that delivering and receiving consistent feedback was relevant to their clinical practice.
An EHR-supported system to deliver timely and relevant PICU patient outcome feedback to referring ED physicians was feasible, usable, and important to physicians. Future work is needed to evaluate impact on clinical practice and patient outcomes and to investigate applicability to other clinical settings involved in similar care transitions.
许多危重症患儿在转入儿科重症监护病房（PICU）之前，首先由接受过不同儿科培训的一线临床医生进行评估。由于临床医生从以往的表现中学习，将患者的结果反馈给提供儿科急诊的一线临床医生可能是有价值的；然而，转诊临床医生并没有持续收到这一重要的反馈。
我们旨在确定在单一机构开发的半自动化电子健康记录（EHR）支持系统向转诊急诊（ED）医生提供及时相关的 PICU 患者预后反馈的可行性、可用性和临床相关性。
在健康信息技术安全框架的指导下，我们在一个机构中迭代设计、实施和评估了一个半自动化的电子反馈系统，利用 EHR。在对利益相关者进行访谈和焦点小组讨论以了解 PICU-ED 医疗保健工作系统之后，我们通过将利益相关者、组织和可用性目标转化为反馈流程和报告要求，设计了 EHR 支持的反馈系统。在 6 个月的时间里，我们完成了三个周期的实施和评估，在此期间，我们分析了 EHR 访问日志，审查了发送的反馈报告，进行了可用性测试，并对医生进行了访谈，以确定系统的可行性、可用性和临床相关性。
EHR 支持的反馈流程具有可行性，可及时提供和接收反馈报告。可用性测试显示出色的系统可用性量表得分。根据医生的反馈，该流程很好地融入了他们的临床工作流程，并且不会增加过多的工作量。医生还表示，提供和接收一致的反馈与他们的临床实践相关。
向转诊 ED 医生提供及时和相关的 PICU 患者预后反馈的 EHR 支持系统是可行的、可用的，并且对医生很重要。未来需要进一步评估其对临床实践和患者结局的影响，并研究其在涉及类似护理转介的其他临床环境中的适用性。
