The main goal of our study was to discover the most crucial information needs of ICU shift leaders that support the coordination of daily care in their fast based units. Our study showed that ICU shift leaders need a wide variety of crucial information for their managerial decisions. Furthermore, the information needs of ICU charge nurses seem to be focused more on the unit level, whereas intensivists concentrate on direct patient care. Most of the crucial information needs of intensivists were related to direct patient care, whereas charge nurses needed more information about resource allocation, and issues concerning organisation and management. These findings are important when information management tools are developed for ICU shift leaders, as different crucial needs would inevitably require different tools to support them. Significantly, to date, only a few studies have focused on multi-professional information needs in ICUs e.g., 1, , and thus these differences are currently underexplored. Furthermore, the focus in previous studies has been on direct patient care, rather than on the entire process of the management of multi-professional activities within ICUs.
We found that the most crucial information needs of ICU shift leaders focused on two areas: one is the state of a patient, especially during the admission phase, including the need to isolate, the need for mechanical ventilation, the urgency level, and planned special treatments; and two, the constantly changing requirements for adequate resource allocation, such as the number of patients, vacant beds, and staffing levels. The most crucial information needs of charge nurses and intensivists differed, even if their goals – a smooth flow of activities and good quality patient care – were the same. The shift leaders also stressed that both the critical state of patients and inadequate resource allocation greatly impact the workflow management of an ICU. However, clearly, both charge nurses and intensivists prioritised the information needs that were essential for ensuring the best possible patient care; only after this was achieved did they address issues related to ensuring sufficient resources in every situation.
Unlike a previous study by Gurses et al. , which did examine the transfer of information and care coordination, but only from a nurse’s perspective, this study considered both nurses and physicians. However, our results are still supported by previous results [1, 12, 19]. Gurses et al.  found that the information needs of trauma hospital nurse coordinators were related to the patients’ state, and resource allocation issues. For example, nurse coordinators needed information about infection results, isolation needs, special equipment, vacant beds, staffing levels, and terms or plans of patient discharge. In the review by Gurses et al.  the information needs of multi-disciplinary rounds were divided into three categories: clinical information, reference information in regards to diagnosis and treatments, and information related to organisational and social issues. The results of this study suggest that the most crucial information needs of intensivists are more closely connected to clinical and reference information, while the most crucial information needs of charge nurses are mainly related to reference and organisational information. The study by Miller et al.  presented similar conclusions, dividing care coordination and management in ICUs into two different information spaces: coordination of resources, and coordination of patient care.
Statistical analysis revealed that charge nurses with 5–10 years of work experience differed from the other groups when regarding information needs under the dimension of ‘organisation and management of work’. A statistically significant difference was found for charge nurses with fewer than 5 years of work experience (p = 0.02). Our results can be explained by a previous study by Benner  as, according to Benner, nurses with 5–10 years of work experience are able to reflect and modify their decision-making in response to rapidly changing situations. Less experienced workers are more rule-based and inflexible, whereas more experienced workers have an intuitive way of working. Charge nurses with 5–10 years of work experience seem to be more confident in defining their immediate and necessary information needs. In addition, the number of beds had an influence on charge nurse’s information needs. Although it is understandable that the coordination of smaller units is easier than those units with beds numbering over 20, and also that the speciality area of the unit might have an influence on the information needs, similar differences were not found between the intensivists. This therefore may reflect that their information needs, related to direct patient care, are better supported.
For ICU shift leaders, handling all of the information needed by memory is impossible. For decisions related to the care coordination, ICU shift leaders must typically gather all of the information required from disparate sources several times during their shift. Gurses et al.  found that nurse coordinators who led patient flow management spent 75% of their round-time exchanging information. Communication with other professionals was the most often-used method of doing this. To be able to control and manage the information flow, nurse coordinators developed a paper-based, non-official summary that they used as an ad hoc information tool. Out of curiosity, our study provided one of the charge nurses with a pedometer, to measure the distance walked when seeking this information; during one morning shift, she walked approximately three-and-a-half kilometres for this purpose, in a unit with an area of 1,100 m2.
Evidently, some of the most crucial information found will endure for longer in the future of ICU workflow management and information exchange. Such crucial information needs might include the information needed to isolate the patient, the patient’s need for mechanical ventilation, the urgency of the patient’s condition, planned special treatments, the number of nursing staff per patient, and staff skills and knowledge. However, this study clearly shows that the crucial information needs of ICU professionals differ, and are based on their roles and tasks within the unit. This study, therefore, could also help software companies improve the usability of their software, as different health professionals may need differently organised screens for the same data. Furthermore, the methodology used in this study can be applied to determine the most important aspects of the information, which could then be shown immediately to the user on-screen.
Limitations and strengths
Our survey is limited to shift leaders in the highest level ICUs, so no generalisations can be made for lower-level units or other professionals working in ICUs. However, the information need statements and study results can be applied to other settings. The survey was conducted in one country and many factors, such as geographical location, cultural elements, specialisation of units, and staff structure or responsibilities may affect what is categorised as the most crucial information for each unit. On the other hand, the study sample was large and the study units successfully represented both charge nurses and intensivists, as well as highest level ICUs with multiple specialities in different parts of the country.
Clearly, the crucial information needs of ICU shift leaders will change over time, and creating a definitive, all-inclusive list of the crucial information needs for ICU shift leaders is impossible. However, the survey used in this study was developed from the findings of our previous observation study , in which a list of information needs from the most important ad hoc decision-making areas of ICU shift leaders was constructed after in-depth analysis. The final survey and concepts used were also evaluated and piloted.
The survey was fairly long, as it included 122 statements, yet the nature of the online format made it easy and quick to complete. In addition, using an online survey was a straightforward and economical method for gathering information from a large group of participants, and no technical problems were encountered. In the future, expanding this survey to include international participants, and thus comparing the common information needs of ICU shift leaders globally, would be of interest.