Physician Perceptions of the Electronic Problem List in Pediatric Trauma Care

Bat-Zion Hose; Peter L. T. Hoonakker; Abigail R. Wooldridge; Thomas B. Brazelton III; Shannon M. Dean; Ben Eithun; James C. Fackler; Ayse P. Gurses; Michelle M. Kelly; Jonathan E. Kohler; Nicolette M. McGeorge; Joshua C. Ross; Deborah A. Rusy; Pascale Carayon

doi:10.1055/s-0039-1677737

Applied Clinical Informatics, Table of Contents

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

Authors

Bat-Zion Hose

¹Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, United States

²Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, Wisconsin, United States
Peter L. T. Hoonakker

²Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, Wisconsin, United States
Abigail R. Wooldridge

³Department of Industrial & Enterprise Systems Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States
Thomas B. Brazelton III

⁴Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
Shannon M. Dean

⁴Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
Ben Eithun

⁵American Family Children’s Hospital, University of Wisconsin School of medicine and Public Health, Madison, Wisconsin, United States
James C. Fackler

⁶Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, United States
Ayse P. Gurses

⁷Center for Health Care Human Factors, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, United States

⁸Department 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

²Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, Wisconsin, United States

⁴Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
Jonathan E. Kohler

⁹Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
Nicolette M. McGeorge

⁷Center for Health Care Human Factors, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, United States
Joshua C. Ross

¹⁰Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
Deborah A. Rusy

¹¹Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
Pascale Carayon

¹Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, United States

²Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, Wisconsin, United States

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

Full Text

References

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