Doctors' perceptions of information utility in neonatal intensive care

Abstract

Context and setting A neonatal intensive care unit (NICU) is a complex environment that requires doctors to have rapid access to accurate patient data. One factor that has been linked to patient error in the NICU is doctor communication. However, resident doctors rarely receive formal instruction in how to identify and communicate the most useful sources of patient information in this setting. Why the idea was necessary Unlike the medical literature, there is no user's guide to patient information in the NICU. Previous studies have identified doctors' preferences to use some sources of patient information over others, but little is known about why doctors make these choices. We wanted to better understand the reasons why doctors choose particular sources of patient information in the NICU. What was done We audiotaped open-ended interviews with faculty neonatologists and paediatric residents (n = 10) who worked in an academic NICU to assess what sources of patient information they considered useful and how they determined the utility of information sources in this setting. The transcribed audiotapes were reviewed by each of the investigators, who developed categories based on his or her interpretation of the doctors' comments. The investigators then met as a group to discuss the definitions of and inclusion criteria for each category. In interpreting the data, we applied a metric of information utility described in the medical literature, which proposes that information is useful if it is valid, relevant and requires little work to obtain. Evaluation of results and impact Doctors perceived the bedside flowsheet, conversations with colleagues, summary notes and electronic medical records to be important sources of information. The least utilised source of information was the daily note written by residents. When asked to identify the utility of a source of information, participants mentioned the ease of obtaining and interpreting the information as well as the accuracy of the information. When asked why residents' daily notes were not used, many doctors responded that they did not use them because they thought they already had the information or because the notes contained information that was incomplete. Of note, doctors used conversation with other doctors to exchange information and ask questions (i.e. to learn) but used conversations with nurses mostly to collect information, not as a source of learning. The relationship between validity, relevance and work used to describe information utility in the medical literature appears to also explain how doctors determine the utility of patient information in the NICU. Factors that affect workload include how easy it is to get to an information source as well as how the information is organised. The social construct of the NICU also seemed to play a role in doctor communication. Doctors in this study reported communicating with each other for reasons different to those for which they communicate with nurses. Studies of airline crews have demonstrated that rigid social hierarchies within crews contribute to failures in communication. Developing a curriculum that highlights how information is obtained and communicated in the NICU may assist residents in navigating this complex information environment.