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Quality & Patient Safety

Research Snapshot Theater: Quality and Patient Safety/Procedures, Adult and Pediatric

(1373) Development of a Workflow Integration Analysis Instrument for EHR-Based ICU Care Intervention

Sunday, February 23, 2025

12:15pm – 1:15pm Eastern Time

Location: Connections Central - RST 14

First Author(s)

Bhavesh Patel, MD

Childrens Hospital of Philadelphia, USA

Co-Author(s)

Takunori Hozumi, MD

The Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, USA
KC

Kenneth Catchpole, PhD

SmartState Endowed Chair
Clinical Practice and Human Factors, Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, United States
MM

Mark Mai, MD, MHS

Assistant Professor, Pediatrics & Clinical Informatic
Children's Hospital of Atlanta, United States
NM

Naveen Muthu, MD

Physician
Children's Healthcare of Atlanta, United States
MA

Michelle Adu-Darko, MD

Physician
University of Virginia, United States
Vinay Nadkarni, MD, MS, FCCM (he/him/his)

Dr.
University of Pennsylvania Perelman School of Medicine, CHOP
Media, Pennsylvania, United States
Akira Nishisaki, MD, MSCE (he/him/his)

Division of Critical Care Medicine, Department of Anesthesia and Critical Care
The Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States

Introduction: The introduction of a decision support tool in the ICU can improve patient care but its impact on workflow can create challenges. Existing tools capture the attitude of clinicians but do not describe workflow changes. We developed a survey to quantitatively evaluate workflow changes after implementation of an electronic health record (EHR)-based tracheal intubation (TI) decision support tool in a large academic pediatric ICU. We hypothesize it is feasible to collect information about workflow challenges from multidisciplinary ICU clinicians using this survey in other ICUs.

Methods: Using the Workflow Integration Analysis (WIA) conceptual model, we interviewed multidisciplinary providers in one ICU after an EHR-based TI decision support tool was introduced. Two content experts conducted an inductive thematic analysis. Themes were converted to survey questions with a Likert scale response (1=Much worse, 3=Neutral, 5=Much better). Each item was mapped to WIA dimensions (time, flow, scope, level) and subdimensions. The survey was piloted in another ICU after the EHR-based TI decision support was introduced. Data are summarized with mean ± standard deviation.

Results: We interviewed 28 providers in the first ICU (7 clinicians [physicians and advanced practice providers], 11 nurses [RN], 10 respiratory therapists [RT]). 22 themes under 9 categories were identified to develop a 12-question survey (semiquantitative WIA tool [sWAT]). Each theme was mapped to WIA subdimensions, creating quantitative scores for each WIA dimension and subdimensions. In the second ICU after the EHR-based TI decision support was introduced, we collected 33 responses (19 clinicians, 10 RNs, 4 RTs) over 1 month. The overall perception was positive with specific dimension scores of time: 3.4 ± 0.8, flow: 3.5 ± 0.8, scope 3.4 ± 0.8, and level 3.5 ± 0.8. Two WIA subdimensions (hospital stay, future readmission) were not mapped, reflecting the intended use of the TI decision support tool within the ICU.

Conclusions: It is feasible to collect information about workflow changes from multidisciplinary clinicians after introducing an the EHR-based TI decision support tool. The sWAT data will inform clinicians on how to best quantify bedside workflow changes with an EHR-based decision support.