Information Sources and Utilization during ICU Clinical Rounds: An Observational Study
CCCF ePoster library. Padiyath A. Nov 1, 2016; 150930; 51
Ashwin Padiyath
Ashwin Padiyath
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Abstract
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Topic: Quality Assurance & Improvement

Information Sources and Utilization during ICU Clinical Rounds: An Observational Study


Padiyath, Ashwin1; Ilan, Roy, MD, MSc, FRCPC2
1School of Medicine, Queen's University, Kingston, Canada; 2Department of Critical Care Medicine, Queen’s University, Kingston, Canada



Abstract:

Introduction
There has been a substantial increase in documented clinical information for ICU patients in recent years (Manor-Shulman et al., 2008). Information access is often cumbersome and time-consuming. This may lead to omission of relevant information while making decisions in a busy environment. There is limited research on how critical care providers navigate, and interact with, this large amount of information.
 
Objectives
To explore how ICU physicians interact with various sources of information during bedside rounds, and how information is related to decisions made.

Methods
Fourteen ICU bedside rounds were captured using three video cameras, including an eye-tracking system worn by the attending physician. A single evaluator then reviewed the footage and various parameters were recorded, including rounds duration, airtime per speaker, attending physician’s visual focus, content of discussion, and timing and type of decisions made. Participating attending physicians were interviewed post production while watching their respective video recordings and identified the decisions made during rounds.
 
Results
At a 33-bed, medical/surgical ICU in Kingston General Hospital, Ontario, 14 bedside rounds, directed by 5 attending physicians, were recorded and analyzed. Median (range) duration of rounds was 12:22 (2:23–18:47) minutes. On average, attending physicians were the main speaker 33% of the time, followed by nurses (27%), trainees (27%), pharmacists (8%) and other team members (3%).

During the rounds, attending physicians focused their visual attention on a median (range) of 26 (9-66) items, spending about 14 (10-18) seconds on each item. Across rounds, attending physicians’ visual focus was on the nurse 21% of the time, followed by residents (18%), paper (16%) and electronic (13%) charts, the patient (11%), other team members (14%), and other objects (7%).

The average amount of content across rounds included discussing, interpreting and planning (56%), nursing report (21%), teaching (8%), looking up information (7%), interacting with patients (7%), interacting with patient families (3%), and transitions (7%). Of the 7% of the time that was allocated to looking up information, lab test results were discussed most commonly (37%), followed by information originally gathered from the bedside monitor (28%), physical findings (14%), devices at the bedside (10%), imaging tests (9%), and lines and tubes (2%).

A median of 9 (2-12) decisions were made per patient rounds, mostly by attending physicians. Decisions were made regarding medications (36%), procedures (30%), tests (16%), directives (e.g. discharging a patient from the ICU, goals of care, etc.) (12%), and consults of other services (6%). About 30% of all decisions were made within the first half of the rounds, and 70% were about equally distributed throughout the second half of the rounds.
 
Conclusion
There was marked variation in the styles employed by each physician and their teams, including variable participation of team members, conversation content, utilization of information, and decision-making. Information was accessed over a relatively small proportion of time. It is likely that improving the access to, and presentation of, information can substantially influence the effectiveness of clinical rounds.
 
Conflicts of Interest
There are no conflicts of interest to disclose.
 


References:

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