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Data Utilization for Medical Decision Making at the Time of Patient Admission to ICU*

Pickering, Brian W. MB, FFARCSI, MSc1,2; Gajic, Ognjen MD, MSc2,3; Ahmed, Adil MD2; Herasevich, Vitaly MD, PhD1,2; Keegan, Mark T. MB, MRCPI, MSc1,2

doi: 10.1097/CCM.0b013e318287f0c0
Clinical Investigations

Objectives: Information overload in electronic medical records can impede providers’ ability to identify important clinical data and may contribute to medical error. An understanding of the information requirements of ICU providers will facilitate the development of information systems that prioritize the presentation of high-value data and reduce information overload. Our objective was to determine the clinical information needs of ICU physicians, compared to the data available within an electronic medical record.

Design: Prospective observational study and retrospective chart review.

Setting: Three ICUs (surgical, medical, and mixed) at an academic referral center.

Subjects: Newly admitted ICU patients and physicians (residents, fellows, and attending staff).

Measurements and Main Results: The clinical information used by physicians during the initial diagnosis and treatment of admitted patients was captured using a questionnaire. Clinical information concepts were ranked according to the frequency of reported use (primary outcome) and were compared to information availability in the electronic medical record (secondary outcome). Nine hundred twenty-five of 1,277 study questionnaires (408 patients) were completed. Fifty-one clinical information concepts were identified as being useful during ICU admission. A median (interquartile range) of 11 concepts (6–16) was used by physicians per patient admission encounter with four used greater than 50% of the time. Over 25% of the clinical data available in the electronic medical record was never used, and only 33% was used greater than 50% of the time by admitting physicians.

Conclusions: Physicians use a limited number of clinical information concepts at the time of patient admission to the ICU. The electronic medical record contains an abundance of unused data. Better electronic data management strategies are needed, including the priority display of frequently used clinical concepts within the electronic medical record, to improve the efficiency of ICU care.

Supplemental Digital Content is available in the text.

1 Department of Anesthesiology, Division of Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, MN.

2 Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), Mayo Clinic College of Medicine, Rochester, MN.

3 Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, MN.

*See also p. 1586.

Dr. Pickering contributed to conception, design, data gathering, analysis, and article preparation. Dr. Herasevich contributed to design, analysis, and article preparation. Dr. Ahmed contributed to data gathering and analysis. Dr. Gajic contributed to conception, design, analysis, and article preparation. Dr. Keegan contributed to conception, design, analysis, and article preparation.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Supported, in part, by Mayo Clinic Critical Care Research Committee.

The authors, Pickering, Gajic, and Herasevich in conjunction with Mayo Clinic, Rochester, have filed a patent entitled "Presentation of Critical Patient Data" with the U.S. patent office which describes a method of organizing data for clinical use in the acute care setting. No monies have been paid to those authors or to the institution for this work.

Drs. Pickering, Gajic, Ahmed, and Herasevich received grant support from the Mayo Clinic. Some of the data presented in this paper has been used in support of an awarded grant from the Center for Medicare and Medicaid Services.

Dr. Keegan lectured for Dannemiller. Dr. Keegan received support for payment for manuscript preparation (current reviews in anesthesiology).

For information regarding this article, E-mail: pickering.brian@mayo.edu

© 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins