Reporting Outcomes of Pediatric Intensive Care Unit Patients to Referring Physicians via an Electronic Health Record-Based Feedback System

Christina L. Cifra; Cody R. Tigges; Sarah L. Miller; Nathaniel Curl; Christopher D. Monson; Kimberly C. Dukes; Heather S. Reisinger; Priyadarshini R. Pennathur; Dean F. Sittig; Hardeep Singh

doi:10.1055/s-0042-1748147

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Reporting Outcomes of Pediatric Intensive Care Unit Patients to Referring Physicians via an Electronic Health Record-Based Feedback System

Christina L. Cifra, Cody R. Tigges, Sarah L. Miller, Nathaniel Curl, Christopher D. Monson, Kimberly C. Dukes, Heather S. Reisinger, Priyadarshini R. Pennathur, Dean F. Sittig and Hardeep Singh

Applied clinical informatics, Vol.13(2), pp.495-503

03/2022

DOI: 10.1055/s-0042-1748147

PMCID: PMC9095343

PMID: 35545126

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Abstract

Abstract Background 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. Objectives 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. Methods 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. Results 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. Conclusion 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.

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Details

Title: Subtitle: Reporting Outcomes of Pediatric Intensive Care Unit Patients to Referring Physicians via an Electronic Health Record-Based Feedback System
Creators: Christina L. Cifra - University of Iowa
Cody R. Tigges - University of Iowa
Sarah L. Miller - University of Iowa
Nathaniel Curl - Trinity Medical Center
Christopher D. Monson - Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
Kimberly C. Dukes - University of Iowa
Heather S. Reisinger - University of Iowa
Priyadarshini R. Pennathur - University of Iowa
Dean F. Sittig - School of Biomedical Informatics, Center for Healthcare Quality and Safety, University of Texas Health Science Center, Houston, Texas, United States
Hardeep Singh - Baylor College of Medicine
Resource Type: Journal article
Publication Details: Applied clinical informatics, Vol.13(2), pp.495-503
DOI: 10.1055/s-0042-1748147
PMID: 35545126
PMCID: PMC9095343
NLM abbreviation: Appl Clin Inform
eISSN: 1869-0327
Publisher: Georg Thieme Verlag KG
Grant note: UL1TR002537 / National Center for Advancing Translational Sciences of the National Institutes of Health NIH K08 grant (HS026965) / Agency for Healthcare Research and Quality (AHRQ) R01HS27363 / University of Iowa Carver College of Medicine Department of Pediatrics UL1TR002537 / NIH Clinical and Translational Science Award CIN 13–413 / Department of Veterans Affairs (VA) Health Services Research and Development Service Center for Innovations in Quality, Effectiveness and Safety
Language: English
Date published: 03/2022
Academic Unit: Critical Care; Stead Family Department of Pediatrics; Emergency Medicine; Industrial and Systems Engineering; Center for Social Science Innovation; General Internal Medicine; Community and Behavioral Health; Internal Medicine
Record Identifier: 9984256770902771

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