Examining Pediatric Resident Electronic Health Records Use During Prerounding: Mixed Methods Observational Study.

BACKGROUND: Electronic health records (EHRs) play a substantial role in modern health care, especially during prerounding, when residents gather patient information to inform daily care decisions of the care team. The effective use of the EHR system is crucial for efficient and frustration-free prerounding. Ideally, the system should be designed to support efficient user interactions by presenting data effectively and providing easy navigation between different pages. Additionally, training on the system should aim to make user interactions more efficient by familiarizing the users with best practices that minimize interaction time while using the full potential of the system's capabilities. However, formal training on EHR systems often falls short of providing residents with all the necessary EHR-related skills, leading to the adoption of inefficient practices and the underuse of the system's full range of capabilities. OBJECTIVE: This study aims to examine the efficiency of EHR use during prerounding among pediatric residents, assess the effect of experience level on EHR use, and identify areas for improvement in EHR design and training. METHODS: A mixed methods approach was used, involving a self-reported survey and video analysis of prerounding practices of the entire population of pediatric residents from a large teaching hospital in the South Atlantic Region. The residents were stratified by experience level by postgraduate year. Data were collected on the number of pages accessed, duration of prerounding, task completion rates, and effective use of data sources. Observational and qualitative data complemented the quantitative analysis. Our study followed the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) reporting guidelines, ensuring completeness and transparency of reporting. RESULTS: Of the 30 pediatric residents, 20 were included in the analyses; of these, 16 (80%) missed at least 1 step during prerounding. Although more experienced residents on average omitted fewer steps, 4 (57%) of the 7 most experienced residents still omitted at least 1 step. On average, residents took 6.5 minutes to round each patient and accessed 21 pages within the EHR during prerounding; no statistically significant differences were observed between experience levels for prerounding times (P=.48) or number of pages accessed (P=.92). The use of aggregated data pages within the EHR system neither seem to improve prerounding times nor decrease the number of pages accessed. CONCLUSIONS: The findings suggest that EHR design should be improved to better support user needs, and hospitals should adopt more effective training programs to familiarize residents with the system's capabilities. We recommend implementing prerounding checklists and providing ongoing EHR training programs for health care practitioners. Despite the generalizability of limitations of our study in terms of sample size and specialization, it offers valuable insights for future research to investigate the impact of EHR use on patient outcomes and satisfaction, as well as identify factors that contribute to efficient and effective EHR usage.

Usability challenges with electronic health records (EHRs) during prerounding on pediatric inpatients.

Objective: Prerounding is critical for a healthcare team to develop a shared understanding of the patient's condition and to develop a care plan. However, the design of electronic health records (EHRs) often makes prerounding inefficient, ineffective, and time consuming. The goal of this study was to observe how residents use the EHR while prerounding to identify usability challenges associated with the design of EHRs. Materials and Methods: Thirty residents were tasked to preround 2 pediatric patients using the think-aloud protocol. The data from the surveys, video recordings, and think-aloud comments were analyzed to identify usability issues related to EHR. The time it took for participants to complete the 6 required prerounding tasks were calculated and the pages most commonly accessed were noted. Results: Participants spent on average 6.5 min prerounding each patient with the most time spent on checking lab results and reviewing notes. Twenty-eight distinct pages were visited by at least 2 participants, mostly due to a lack of interconnectivity between related data across pages. Usability issues with the most commonly used pages include: data overload, missing/hidden information, difficulty identifying trends, and having to conduct manual calculations. Conclusions: We list usability issues and provide a set of recommendations to remedy these issues that include: reducing information access cost, creating a checklist, automate calculations, and standardizing notes and EHR training. Ideally, the outcome of this work will help improve EHR design to maximize the time clinicians spend interacting with and providing care to their patients.

At Work in a Pandemic: Black Workers' Experiences of Safety on the Job.

Race and labor scholars have argued that precarious, dangerous work, along with the work of social reproduction, has long been disproportionately placed on Black workers. This research examines how the COVID-19 pandemic impacted essential in-person workers differently by race. Using data collected from approximately 8,000 respondents in five survey waves, we find that Black essential and in-person workers were far more likely to experience safety concerns on the job than white workers, from inadequate sick leave and protective gear in the early pandemic to customers who refused to mask in later months. This pattern extended to stress off the job, where Black workers were more likely to have experienced food, childcare, and housing insecurities. Black workers were also more likely to be interested in unionization. These findings point to distinct ways in which the COVID-19 pandemic has collided with Black workers' struggle for economic inequality and amplified existing patterns of labor market inequality.

Strategies of emotion management: not just on, but off the job.

Intensive care nurses, like professionals in other intense occupations characterized by high degrees of uncertainty, manage the emotions that result from their work both on and off the job. We focus on the job strategies - calling-in, sharing their experiences with others and engaging in a range of activities oriented to emotional recovery - that 37 intensive care nurses use to manage their emotions off the job. These strategies show how the social organization and division of labor in intensive care units influences nurses' emotional management outside of them and how organizational troubles for hospitals becomes personal ones for staff. They further support theoretical approaches that view emotions as dynamic elements belonging to individuals rather than aspects of people that can be fully appropriated by organizations.

Reconsidering detached concern: the case of intensive-care nurses.

The concept of detached concern, as proposed by Renée Fox in Experiment Perilous (1959), is often used in the literature today in a way she did not intend. Rather than viewing detachment and concern as dualities, scholars frequently conceive of them as dichotomous, emphasizing detachment over concern. We reconsider detached concern here through the stories 37 intensive-care nurses told about their most memorable patients. While many described efforts to keep emotionally distant from patients, they also expressed concern for patients they felt connected to, especially those who were a first for them, who were long-term primary patients, who surprised them, or who died. The care nurses provide for these patients is shaped sociologically by their training and institutional contexts and is not an aberration or indicative of their losing control of their feelings. Instead, it is evidence of the dual nature of detached concern and of the importance of viewing the concept as describing more than emotional detachment.