Table 5.
Clinician-Recommended Strategies to Improve Situational Awareness and Efficiency Grouped by Survey Theme
| Practice | Example | Socio-technical dimension | Efficiency and SA impact* |
|---|---|---|---|
| Inbox content should be actionable for patient care and relevant to recipient clinician | |||
| Leadership and IT reviews the types of messages sent, and only transmit those likely to influence patient care. | • Remove automated for-your-information-only messages that do not impact care, like “height and weight collected.” | Content | Efficiency and SA level 1 |
| Inboxes should reduce risk of losing of messages | |||
| When future action is needed, use reminder features to de-clutter inbox. | • Set future reminder to follow-up on repeat chest imaging results. | Hardware and software | SA levels 1–3 |
| Inbox functionality should be optimized to improve efficiency of processing notifications | |||
| Use macros to increase the efficiency of repetitive actions. | • Macro to automatically route appropriate messages to nursing staff. | Content | Efficiency |
| Use templated text (or voice recognition software) to quickly populate frequently used messages. | • Templated text to describe abnormal cholesterol results and need to improve exercise and diet. | Content | Efficiency |
| Customize and use order preference lists. | • Preference list item for metformin 500 mg with “BID,” “180 tablets,” and “3 refills” preset. | Content | Efficiency |
| Set up your quick routing list for recipients who commonly receive messages. | • Button to automatically add the clinic’s nursing pool to the “To:” field of a message. | Content | Efficiency |
| Actively sign patients up for a portal to facilitate test result release. | • Process to release non-urgent test results to portal is more efficient than generating letters or phone calls. | Workflow | Efficiency |
| When unable to process message immediately, add message comments as reminders of message content. | • Adding “Waiting for forms” comment to a telephone message. | User interface | SA level 1 |
| Develop inbox views that reveal information that is commonly required for decision-making, but prevent the need to open the patient’s full chart. | • EHR features displaying the current medication list when processing refill requests. | Hardware/software and user interface | Efficiency and SA levels 1–3 |
| Team support should be leveraged to help with EHR inbox notification burden | |||
| Allow staff to pre-load orders when patients call requesting refills, test orders, or referrals. | • Allow staff to pre-load referral order when patient calls requesting referral. Physician can approve or cancel referral quicker than entering de novo. | Workflow | Efficiency |
| Sufficient time should be provided to all clinicians to process EHR inbox notifications | |||
| Allow sufficient and distraction-free time for non-face-to-face activities. | • Scheduling designated distraction-free inbox management time. | Organizational policies and workflows | Efficiency and SA levels 1–4 |
*Situational awareness (SA) level 1 = perception of information in the environment; SA level 2 = comprehension of their meaning; SA level 3 = projection of their status in the near future; SA level 4 = awareness of the best path to follow