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Appl Clin Inform 2019; 10(01): 113-122
DOI: 10.1055/s-0039-1677737
Research Article
Georg Thieme Verlag KG Stuttgart · New York

Physician Perceptions of the Electronic Problem List in Pediatric Trauma Care

Bat-Zion Hose
1   Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, United States
2   Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, Wisconsin, United States
,
Peter L. T. Hoonakker
2   Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, Wisconsin, United States
,
Abigail R. Wooldridge
3   Department of Industrial & Enterprise Systems Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States
,
Thomas B. Brazelton III
4   Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
,
Shannon M. Dean
4   Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
,
Ben Eithun
5   American Family Children’s Hospital, University of Wisconsin School of medicine and Public Health, Madison, Wisconsin, United States
,
James C. Fackler
6   Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, United States
,
Ayse P. Gurses
7   Center for Health Care Human Factors, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, United States
8   Department of Anesthesiology and Critical Care Medicine, School of Medicine; Department of Health Sciences Informatics, School of Medicine; Department of Health Policy and Management, Bloomberg School of Public Health; Carey Business School; Malone Center for Engineering in Healthcare, Whiting School of Engineering; Johns Hopkins University, Baltimore, Maryland, United States
,
Michelle M. Kelly
2   Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, Wisconsin, United States
4   Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
,
Jonathan E. Kohler
9   Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
,
Nicolette M. McGeorge
7   Center for Health Care Human Factors, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, United States
,
Joshua C. Ross
10   Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
,
Deborah A. Rusy
11   Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
,
Pascale Carayon
1   Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, United States
2   Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, Wisconsin, United States
› Author Affiliations Funding Funding for this research was provided by the Agency for Healthcare Research and Quality (Grant No. R01 HS023837). The project described was also supported by the Clinical and Translational Science Award program through the National Institutes of Health (NIH) National Center for Advancing Translational Sciences (Grant UL1TR002373). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.
Further Information

Publication History

16 September 2018

10 December 2018

Publication Date:
13 February 2019 (online)

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Abstract

Objective To describe physician perceptions of the potential goals, characteristics, and content of the electronic problem list (PL) in pediatric trauma.

Methods We conducted 12 semistructured interviews with physicians involved in the pediatric trauma care process, including residents, fellows, and attendings from four services: emergency medicine, surgery, anesthesia, and pediatric critical care. Using qualitative content analysis, we identified PL goals, characteristics, and patient-related information from these interviews and the hospital's PL etiquette document of guideline.

Results We identified five goals of the PL (to document the patient's problems, to make sense of the patient's problems, to make decisions about the care plan, to know who is involved in the patient's care, and to communicate with others), seven characteristics of the PL (completeness, efficiency, accessibility, multiple users, organized, created before arrival, and representing uncertainty), and 22 patient-related information elements (e.g., injuries, vitals). Physicians' suggested criteria for a PL varied across services with respect to goals, characteristics, and patient-related information.

Conclusion Physicians involved in pediatric trauma care described the electronic PL as ideally more than a list of a patient's medical diagnoses and injuries. The information elements mentioned are typically found in other parts of the patient's electronic record besides the PL, such as past medical history and labs. Future work is needed to evaluate the optimal design of the PL so that users with emergent cases, such as pediatric trauma, have access to key information related to the patient's immediate problems.

Keywords

problem-oriented model - patient safety - human factors engineering - pediatric trauma - care coordination

Protection of Human and Animal Subjects

This study was reviewed by the University of Wisconsin-Madison Institutional Review Board and was provided exemption.


 

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