Abstract
Objectives Intensive care unit (ICU) direct care nurses spend 22% of their shift completing
tasks within the electronic health record (EHR). Miscommunications and inefficiencies
occur, particularly during patient hand-off, placing patient safety at risk. Redesigning
how direct care nurses visualize and interact with patient information during hand-off
is one opportunity to improve EHR use. A web-based survey was deployed to better understand
the information and visualization needs at patient hand-off to inform redesign.
Methods A multicenter anonymous web-based survey of direct care ICU nurses was conducted
(9–12/2021). Semi-structured interviews with stakeholders informed survey development.
The primary outcome was identifying primary EHR data needs at patient hand-off for
inclusion in future EHR visualization and interface development. Secondary outcomes
included current use of the EHR at patient hand-off, EHR satisfaction, and visualization
preferences. Frequencies, means, and medians were calculated for each data item then
ranked in descending order to generate proportional quarters using SAS v9.4.
Results In total, 107 direct care ICU nurses completed the survey. The majority (46%, n = 49/107) use the EHR at patient hand-off to verify exchanged verbal information.
Sixty-four percent (n = 68/107) indicated that current EHR visualization was insufficient. At the start
of an ICU shift, primary EHR data needs included hemodynamics (mean 4.89 ± 0.37, 98%,
n = 105), continuous IV medications (4.55 ± 0.73, 93%, n = 99), laboratory results (4.60 ± 0.56, 96%, n = 103), mechanical circulatory support devices (4.62 ± 0.72, 90%, n = 97), code status (4.40 ± 0.85, 59%, n = 108), and ventilation status (4.35 + 0.79, 51%, n = 108). Secondary outcomes included mean EHR satisfaction of 65 (0–100 scale, standard
deviation = ± 21) and preferred future EHR user-interfaces to be organized by organ
system (53%, n = 57/107) and visualized by tasks/schedule (61%, n = 65/107).
Conclusion We identified information and visualization needs of direct care ICU nurses. The
study findings could serve as a baseline toward redesigning an EHR interface.
Keywords
data visualization - intensive care unit - nurse - electronic health record
