Accuracy of Laboratory Data Communication on ICU Daily Rounds Using an Electronic Health Record

Kathryn A. Artis, Edward Dyer, Vishnu Mohan, Jeffrey (Jeff) Gold

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

OBJECTIVES:: Accurately communicating patient data during daily ICU rounds is critically important since data provide the basis for clinical decision making. Despite its importance, high fidelity data communication during interprofessional ICU rounds is assumed, yet unproven. We created a robust but simple methodology to measure the prevalence of inaccurately communicated (misrepresented) data and to characterize data communication failures by type. We also assessed how commonly the rounding team detected data misrepresentation and whether data communication was impacted by environmental, human, and workflow factors. DESIGN:: Direct observation of verbalized laboratory data during daily ICU rounds compared with data within the electronic health record and on presenters’ paper prerounding notes. SETTING:: Twenty-six-bed academic medical ICU with a well-established electronic health record. SUBJECTS:: ICU rounds presenter (medical student or resident physician), interprofessional rounding team. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: During 301 observed patient presentations including 4,945 audited laboratory results, presenters used a paper prerounding tool for 94.3% of presentations but tools contained only 78% of available electronic health record laboratory data. Ninty-six percent of patient presentations included at least one laboratory misrepresentation (mean, 6.3 per patient) and 38.9% of all audited laboratory data were inaccurately communicated. Most misrepresentation events were omissions. Only 7.8% of all laboratory misrepresentations were detected. CONCLUSION:: Despite a structured interprofessional rounding script and a well-established electronic health record, clinician laboratory data retrieval and communication during ICU rounds at our institution was poor, prone to omissions and inaccuracies, yet largely unrecognized by the rounding team. This highlights an important patient safety issue that is likely widely prevalent, yet underrecognized.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.

Original languageEnglish (US)
JournalCritical Care Medicine
DOIs
StateAccepted/In press - Sep 20 2016

Fingerprint

Electronic Health Records
Communication
Workflow
Information Storage and Retrieval
Licensure
Patient Safety
Data Accuracy
Medical Students
Observation
Physicians

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Accuracy of Laboratory Data Communication on ICU Daily Rounds Using an Electronic Health Record. / Artis, Kathryn A.; Dyer, Edward; Mohan, Vishnu; Gold, Jeffrey (Jeff).

In: Critical Care Medicine, 20.09.2016.

Research output: Contribution to journalArticle

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abstract = "OBJECTIVES:: Accurately communicating patient data during daily ICU rounds is critically important since data provide the basis for clinical decision making. Despite its importance, high fidelity data communication during interprofessional ICU rounds is assumed, yet unproven. We created a robust but simple methodology to measure the prevalence of inaccurately communicated (misrepresented) data and to characterize data communication failures by type. We also assessed how commonly the rounding team detected data misrepresentation and whether data communication was impacted by environmental, human, and workflow factors. DESIGN:: Direct observation of verbalized laboratory data during daily ICU rounds compared with data within the electronic health record and on presenters’ paper prerounding notes. SETTING:: Twenty-six-bed academic medical ICU with a well-established electronic health record. SUBJECTS:: ICU rounds presenter (medical student or resident physician), interprofessional rounding team. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: During 301 observed patient presentations including 4,945 audited laboratory results, presenters used a paper prerounding tool for 94.3{\%} of presentations but tools contained only 78{\%} of available electronic health record laboratory data. Ninty-six percent of patient presentations included at least one laboratory misrepresentation (mean, 6.3 per patient) and 38.9{\%} of all audited laboratory data were inaccurately communicated. Most misrepresentation events were omissions. Only 7.8{\%} of all laboratory misrepresentations were detected. CONCLUSION:: Despite a structured interprofessional rounding script and a well-established electronic health record, clinician laboratory data retrieval and communication during ICU rounds at our institution was poor, prone to omissions and inaccuracies, yet largely unrecognized by the rounding team. This highlights an important patient safety issue that is likely widely prevalent, yet underrecognized.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.",
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N2 - OBJECTIVES:: Accurately communicating patient data during daily ICU rounds is critically important since data provide the basis for clinical decision making. Despite its importance, high fidelity data communication during interprofessional ICU rounds is assumed, yet unproven. We created a robust but simple methodology to measure the prevalence of inaccurately communicated (misrepresented) data and to characterize data communication failures by type. We also assessed how commonly the rounding team detected data misrepresentation and whether data communication was impacted by environmental, human, and workflow factors. DESIGN:: Direct observation of verbalized laboratory data during daily ICU rounds compared with data within the electronic health record and on presenters’ paper prerounding notes. SETTING:: Twenty-six-bed academic medical ICU with a well-established electronic health record. SUBJECTS:: ICU rounds presenter (medical student or resident physician), interprofessional rounding team. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: During 301 observed patient presentations including 4,945 audited laboratory results, presenters used a paper prerounding tool for 94.3% of presentations but tools contained only 78% of available electronic health record laboratory data. Ninty-six percent of patient presentations included at least one laboratory misrepresentation (mean, 6.3 per patient) and 38.9% of all audited laboratory data were inaccurately communicated. Most misrepresentation events were omissions. Only 7.8% of all laboratory misrepresentations were detected. CONCLUSION:: Despite a structured interprofessional rounding script and a well-established electronic health record, clinician laboratory data retrieval and communication during ICU rounds at our institution was poor, prone to omissions and inaccuracies, yet largely unrecognized by the rounding team. This highlights an important patient safety issue that is likely widely prevalent, yet underrecognized.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.

AB - OBJECTIVES:: Accurately communicating patient data during daily ICU rounds is critically important since data provide the basis for clinical decision making. Despite its importance, high fidelity data communication during interprofessional ICU rounds is assumed, yet unproven. We created a robust but simple methodology to measure the prevalence of inaccurately communicated (misrepresented) data and to characterize data communication failures by type. We also assessed how commonly the rounding team detected data misrepresentation and whether data communication was impacted by environmental, human, and workflow factors. DESIGN:: Direct observation of verbalized laboratory data during daily ICU rounds compared with data within the electronic health record and on presenters’ paper prerounding notes. SETTING:: Twenty-six-bed academic medical ICU with a well-established electronic health record. SUBJECTS:: ICU rounds presenter (medical student or resident physician), interprofessional rounding team. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: During 301 observed patient presentations including 4,945 audited laboratory results, presenters used a paper prerounding tool for 94.3% of presentations but tools contained only 78% of available electronic health record laboratory data. Ninty-six percent of patient presentations included at least one laboratory misrepresentation (mean, 6.3 per patient) and 38.9% of all audited laboratory data were inaccurately communicated. Most misrepresentation events were omissions. Only 7.8% of all laboratory misrepresentations were detected. CONCLUSION:: Despite a structured interprofessional rounding script and a well-established electronic health record, clinician laboratory data retrieval and communication during ICU rounds at our institution was poor, prone to omissions and inaccuracies, yet largely unrecognized by the rounding team. This highlights an important patient safety issue that is likely widely prevalent, yet underrecognized.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.

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