Impact of Patient Census and Admission Mortality on Pediatric Intensive Care Unit Attending Electronic Health Record Activity: A Preliminary Study

Conrad Krawiec; Christy Stetter; Lan Kong; Paul Haidet

doi:10.1055/s-0040-1705108

Applied Clinical Informatics, Inhaltsverzeichnis

Appl Clin Inform 2020; 11(02): 226-234
DOI: 10.1055/s-0040-1705108

Research Article

Georg Thieme Verlag KG Stuttgart · New York

Impact of Patient Census and Admission Mortality on Pediatric Intensive Care Unit Attending Electronic Health Record Activity: A Preliminary Study

Authors

Conrad Krawiec

¹Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Penn State Hershey College of Medicine, Penn State Hershey Children's Hospital, Hershey, Pennsylvania, United States
Christy Stetter

²Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, United States
Lan Kong

²Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, United States
Paul Haidet

³Office for Scholarship in Learning and Education Research, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, United States

⁴Department of Medicine, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, United States

⁵Department of Humanities, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, United States

Abstract

Background Physicians may spend a significant amount of time using the electronic health record (EHR), but this is understudied in the pediatric intensive care unit (PICU). The objective of this study is to quantify PICU attending physician EHR usage and determine its association with patient census and mortality scores.

Methods During the year 2016, total EHR, chart review, and documentation times of 7 PICU physicians were collected retrospectively utilizing an EHR-embedded time tracking software package. We examined associations between documentation times and patient census and maximum admission mortality scores. Odds ratios (ORs) are reported per 1-unit increase in patient census and mortality scores.

Results Overall, total daily EHR usage time (median time [hh:mm] [25th, 75th percentile]) was 2:10 (1:31, 3:08). For all hours (8 a.m.–8 a.m.), no strong association was noted between total EHR time, chart review, and documentation times and patient census, Pediatric Index of Mortality 2 (PIM2), or Pediatric Risk of Mortality 3 (PRISM3) scores. For regular hours (8 a.m.–7 p.m.), no strong association was noted between total EHR, chart review, and documentation times and patient census, PIM2, or PRISM3 scores. When patient census was higher, the odds of EHR after-hour usage (7 p.m.–8 a.m.) was higher (OR 1.262 [1.135, 1.403], p < 0.0001), but there were no increased odds with PIM2 (OR 1.090 [0.956, 1.242], p = 0.20) and PRISM3 (OR 1.010 [0.984, 1.036], p = 0.47) scores. A subset of physicians spent less time performing EHR-related tasks when patient census and admission mortality scores were elevated.

Conclusion We performed a novel evaluation of physician EHR workflow in our PICU. Our pediatric critical care physicians spend approximately 2 hours (out of an expected 10-hour shift) each service day using the EHR, but there was no strong or consistent association between EHR usage and patient census or mortality scores. Future larger scale studies are needed to ensure validity of these results.

Keywords

intensive and critical care - electronic health records and systems - inpatient care - workflow - pediatrics - attending rounds - residency - patient care

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