Abstract
Objectives
While nursing summaries in electronic health records are used for initial orientation
to a patient's status, research on nurses' use of these summaries remains scarce.
This case study conducted an eye-tracking simulation to identify (1) key information
types (orders, vital signs, etc.), (2) frequently paired information types, and (3)
common sequential patterns of information types within nursing summaries as nurses
review simulated patient cases.
Methods
We recruited 33 medical-surgical nurses from a university hospital. As part of an
eye-tracking simulation, they reviewed three simulated patients' nursing summaries.
A screen-based eye-tracker was used to capture participants' gaze fixation on different
information types. For analysis, we used discrete-time Markov chains and sequential
pattern mining.
Results
The average total gaze fixation time was 1.77 minutes from 26 analyzed participants'
eye gaze data. Most of this time was spent shifting between information types or making
notes. “Orders” and “Sidebar” (mini summary of demographics and health status) were
the information types that consistently emerged as key areas of focus. Participants
tended to read specific information types in pairs and followed a top-to-bottom order
of reading on the screen.
Conclusion
When reviewing unfamiliar patient cases, nurses prefer to construct a comprehensive
patient narrative. Nursing summaries can be redesigned by prioritizing key information
types, grouping relevant information pairs, and arranging information in a top-to-bottom
manner based on relevance. We recommend that hospitals and EHR vendors prioritize
the customization of nursing summaries to align with nurses' information needs and
workflows. Tailored summary layout improvements beyond a one-size-fits-all design,
informed by interdisciplinary collaboration, can enhance information reading efficiency.
Keywords
cognition - electronic health records and systems - interfaces and usability - nurse
- temporal data mining
