1032: CRITICAL CARE CLINICIAN NEEDS FOR PRIORITIZATION OF CARE IN INTENSIVE CARE UNIT: A QUALITATIVE STUDY

Abstract

Introduction: To adequately care for groups of acutely ill patients, clinicians need to develop and maintain situational awareness to inform care prioritization. Our objective was to understand the information and process needs that support patient prioritization by clinicians caring for multiple patients in intensive care unit (ICU) and to inform the refinement of an acute care multi patient viewer (MPV), that was designed to assist clinicians in patient prioritization. Methods: We conducted semi-structured 1:1 interviews of ICU clinicians who had experience working with a MPV in three quaternary care academic hospitals. All interviews were audio recorded in Zoom and transcribed verbatim. De-identified interview transcripts were analyzed with open, axial, and selective coding using grounded theory approaches. Data was managed using NVivo 12 software. Results: We interviewed 20 clinicians. We identified 5 main themes following data analysis: 1) strategies used to enable patient prioritization, 2) strategies for optimizing task organization, 3) information and factors helpful for situational awareness of entire ICU, 4) unrecognized or missed critical events and information, and 5) suggestions for MPV organization and content. ICU patient prioritization was mainly driven by patient severity of illness, the trajectory of the patient clinical status, the information received from the bedside nurses, and the information received during the sign-out. Initial task prioritization was based on patient instability, followed by time-sensitive patient needs. Approaches to maintaining situational awareness included communication with colleagues, reviewing data in the electronic medical records and MPV, and being physically present in the ICU. Interviewees noted the usefulness of an MPV for prioritization of ICU care, and gave suggestions on data content, visualization, and usability. Conclusions: This qualitative study explored ICU clinician perspectives about their information and process needs to enable the prioritization of care among ICU patients and gathered insights on organization of data within the MPV. Timely recognition of changes in patient physiology and labs, and avoiding omissions and errors in patient management were perceived opportunities for improvement in preventing catastrophic events in the ICU.