Digital challenges: media discontinuities and errors despite electronic patient records

In Swiss hospitals, nursing staff sometimes still record important patient data on paper despite the rise of digitalisation. Such media discontinuity leads to errors. The research being done in NRP 77 offers solutions.

How does clinical patient information get to the right department in a hospital, and to the right person? Even now, these exchanges take place in various forms – whether verbal, written or digital. Patrizia Salzmann’s team at the Swiss Federal University for Vocational Education and Training, working together with Thomas Bürkle’s Medical Informatics team at Bern University of Applied Sciences, have closely monitored the digital transfer of clinical patient information in a total of six hospitals. They identified six key moments for the transfer of information: 1.) dispensing of medicines 2.) shift handover 3.) patient admission, transfer, discharge 4.) medical/nursing visit 5.) input, and 6.) adding and editing clinical patient information.

The research team identified the digital skills that nursing staff need for these tasks, and used them to design learning tools for the training and further education of nursing staff. The first learning tool is an interactive 360-degree video on the topic of shift handovers (in german only) :

The research team also developed text-based learning situations for other key moments in the transfer of information.

Clinical information systems: challenges and solutions

The clinical information systems used for forwarding information – and their user-friendliness – were another core area of the study. In the hospitals, a large number of IT-related events were documented in which media discontinuities and misinformation occurred, or where the IT systems encountered technical problems or were not user-friendly.

The most relevant events were selected in close collaboration with the nursing staff observed. One critical point was a personal worklist, which the nursing staff drew up on paper at the beginning of the shift.

As an example of a digitalised process, a mock-up was developed in which such a worklist can be compiled in the clinical information system and then transferred to a mobile device. Another mock-up digitally maps the workflow for the transfer of patients for surgery as well as the paper-based checklists currently being used. It is based on a tablet PC with all the relevant information in digital form, which accompanies the patient through the hospital.

Problems in digital order communication were also analysed, and improved digital workflows were developed. All the tools were tested and validated in workshops with the practice partners.

Three key messages from the project

  1. Digital skills are not explicitly included in the current curriculum framework for nursing students. Growing digitalisation in the healthcare sector and the relevant skills requirements call for new training and further education tools in nursing. These must take current and future digital work practices into account. The real-life work situations and associated skills requirements documented in the Digi-Care project can serve as a guide for updating the curriculum framework for nursing.
  2. Despite the advanced digitalisation in hospitals and widely established electronic patient records, important documentation activities are still being done in parallel on paper, leading to media discontinuities and heightening the risk of errors. Technical solutions are required to develop suitable digital processes and to improve the usability of the IT systems.
  3. Some of the usability problems observed in this project could have been avoided if close cooperation had already been established between the medical informatics developers and medical staff during the development of the IT system. The implementation of this kind of collaborative design approach depends on the willingness of the IT developers and medical staff, as well as on the resources provided.