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Title Information Seeking in the NICU: Resident and Faculty Perspectives
Author(s) Patrick J. Brown MD, Stephen M. Borowitz MD, Wendy M. Novicoff PhD
Source AMIA 2003 Symposium Proceedings, Pages 796-796
Publication Date Nov. 2003
Abstract Abstract Little is know about how physicians utilize sources of patient information in complex medical environments such as the NICU. We conducted a qualitative study to investigate what sources of patient information physicians prefer to use in this setting. Results reveal a preference for physicians to use conversations with colleagues and the bedside flowsheet the majority of the time. Notes written by physicians - especially resident physicians - were used less frequently. Introduction The neonatal intensive care unit (NICU) is a complex environment that requires physicians to manage multiple pieces of patient information at a hectic pace. Despite its complexity, very little is know about how physicians navigate the maze of patient information in this setting. Studies of physicians' information-seeking behaviors in the library1 and the ambulatory clinic2 have demonstrated a preference for physicians to use conversations with colleagues rather than text sources to meet their information needs. Studies of intensive care units3 have investigated how information is packaged or "bundled" by physicians but few studies have addressed what sources of information physicians actually use in these settings. In order to investigate physicians' information seeking behaviors in the NICU, we conducted a qualitative study at an academic medical center. Methods A self-report survey was administered to pediatric residents and faculty (N=46) at an academic teaching hospital. Respondents were asked to report the frequency (range -2 to +2) with which they utilized different sources of information in the NICU. Mean responses of all respondents were analyzed to determine what sources of information were used. Faculty and resident responses were compared by ttests. Results Of the options listed in our survey, the three most frequently utilized sources were: Bedside flowsheets (mean 1.5); Conversations with resident physicians (mean 1.4); and Conversations with nurses (mean 1.2). Notes written by faculty or residents were utilized less frequently. The least utilized source of information was the daily note written by the residents. Comparison between faculty and resident responses revealed a high level of agreement on the use of the flowsheet as well as the use of conversations with colleagues. Faculty members were more likely than residents to utilize the faculty admission note (p<0.05) and the faculty daily note (p<0.05). While the faculty did not utilize the resident note very often, residents almost never used this note as a source of patient information (p<0.00). Conclusions Physicians in the NICU frequently utilize conversations with colleagues and the bedside flowsheet as a source of information. Notes written by physicians are less frequently used. We speculate that conversations and the flowsheet are utilized because they offer fast and convenient ways for physicians to obtain relevant patient information. Understanding how and why physicians utilize existing information sources in the NICU may help direct the construction and utilization of electronic patient records in this complex environment.

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