Electronic Health Record Workflows in Acute Care Surgery: Ethnographic Study

The useful part

Systematic strategies to harness electronic health record (EHR) workflows, reduce redundancy, and support decision-making remain limited in acute care surgery (ACS). This study aimed to evaluate how ACS clinicians leverage the EHR for decision-making and to identify opportunities and challenges for EHR-enabled decision support. Using constructivist grounded theory, we identified the enablers, challenges, and opportunities for EHR-enabled decision-making in ACS.

How it works

• EHR use during decision-making focused primarily on risk assessment, though navigation challenges hindered access to critical data.
• Streamlined risk assessment using EHR data may strengthen decision-making in critical moments, but solutions must integrate seamlessly within existing workflows to provide rapid and accurate outputs that...
• We conducted a qualitative ethnographic study over a 6-month period, combining in-depth interviews with 15 ACS surgeons and providers and 100 hours of "paired fieldwork" observations spanning the entire...
• Ambiguity in billing requirements drove overdocumentation, resulting in "note bloat" that obscured high-yield information.
• Forecasting key outcomes that alter management or facilitate shared decision-making was seen as valuable.

What to take from it

Surgeons fell into two groups: (1) those who accepted information overload as inherent to the EHR, relying on generic templates and standard attestations, and (2) others who viewed it as a problem to fix, actively correcting errors and composing individualized summaries. Conclusions: ACS clinicians use various tactics to navigate EHR challenges and focus on high-value tasks.

Details worth keeping

improving decision-making and outcomes in ACS.