Communication is one of the key causes of healthcare-related harm. An estimated 210,000 to 400,000 deaths each year in the United States are attributed to healthcare-related harm. Interprofessional communication and collaboration have been identified as critical to providing safe care. Documentation is intended to support interprofessional communication and collaboration. However, research has demonstrated that documentation in the electronic health record (EHR) is not regularly used to support interprofessional communication. Previous research has examined the use of the patient record for information sharing and has identified several barriers that inhibit its use for communication; yet, little is known regarding how the record ought to be used for interprofessional communication.
Healthcare-associated infections (HAI), including central line associated-blood stream infections (CLABSI), is one category of healthcare-associated harm. The purpose of this study was to describe, using the Delphi technique, what an expert panel of nurses and physicians believe regarding how the EHR ought to be used to optimize interprofessional communication in central venous catheter (CVC) management and prevention of CLABSI. The study was guided by the frameworks of Distributed Cognition and Coiera’s Communication Space.
The expert panel consisted of six nurses and four physicians from a large academic healthcare system who had experience caring for patients with CVCs and using the EHR for retrieving, documenting, and communicating information. The panel members held such positions as staff nurse, nurse leader, resident, attending, and physician leader/medical director. Four Delphi rounds, which included an initial individual interview followed by three survey rounds, were completed to achieve stability in panel member responses.
The panel identified 12 information types necessary for decisions regarding whether to keep or discontinue a CVC, the best channels for communicating each of the information types, and factors that promote or inhibit the use of the EHR for interprofessional communication.
The findings have implications for the creation of interprofessional practice guidelines, interprofessional education, and the development of EHRs that better support interprofessional communication and team-based care. Understanding how to optimize the EHR in order to leverage the knowledge captured in clinicians’ documentation has the potential to improve patient care and reduce harm.
|Commitee:||Collins, Sarah A., McDermott-Levy, Ruth|
|School Location:||United States -- Pennsylvania|
|Source:||DAI-B 80/04(E), Dissertation Abstracts International|
|Subjects:||Nursing, Bioinformatics, Information science|
|Keywords:||Central venous catheters, Delphi technique, Documentation, Electronic health records, Interdisciplinary communication, Physicians|
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