Evaluation of User Interface and Workflow Design of a Bedside Nursing Clinical Decision Support System
Yuan, M. J., Finley, G. M., Long, J., Mills, C., & Johnson, R. K. (2013). Evaluation of User Interface and Workflow Design of a Bedside Nursing Clinical Decision Support System. Interactive Journal of Medical Research, 2(1), e4. doi:10.2196/ijmr.2402 
Clinical decision support systems (CDSS) are important tools to improve health care outcomes and reduce preventable medical adverse events.However, CDSS implementations that do not fit local practices and are not tailored to the users' requirements and workflows often have issues with usability, having a negative impact on their effectiveness and on clinical outcomes. Hence usability design and validation in the clinical settings in which the CDSS would be used is a critical aspect of a successful CDSS implementation.
The FTR is a leading patient safety indicator with the highest incident rates among all indicators according to a recent largescale study . It is considered that nurses' early recognition, evaluation of changing patient symptoms has an impact on FTR. Also because of differing educational levels, limited intervention authorizations, communication issues with physicians or rapid response teams as well as heavy workloads and fatigue issues, nurses need a customized CDSS adapted to their workflow nd comfort level.
The authors developed a CDSS for the CHRISTUS St. Michael health system (a 350 bed acute care hospital)with a goal to reduce preventable failure to rescue (FTR) cases in the hospital. The system was aimed at helping frontline nurses better manage critical symptom changes in hospitalized patients, hence reducing preventable FTR cases. In this paper, they discuss the design, evaluation, implementation, and validation of the CDSS UI.
The authors used the UFuRT (user, function, representation, and task analysis application to design the CDSS -user centered design. Therefore, they designed visual and representation analysis.The user interface and workflow design were evaluated via heuristic and end user performance evaluation. The heuristic evaluation was done after the first prototype with evaluators having strong domain expertise. The heuristic evaluation results were incorporated into the product before the end user evaluation was conducted. A panel of nurses (3 licensed vocational nurses and 7 registered nurses) carried out the end user evaluation via simulated use cases, where the successful completion of sessions and completion time were recorded. Each nurse was asked to use the National Aeronautics and Space Administration (NASA) Task Load Index to selfevaluate the amount of cognitive and physical burden associated with using the device.
A total of 83 heuristic violations were identified in the studies.All violations above grade 3 (major usability problem) were fixed in the prototype before user evaluation. The nurse evaluators successfully completed all 30 sessions of the performance evaluations. All nurses were able to use the device after a single training session. On average, the nurses took 111 seconds (SD 30 seconds) to complete the simulated task. The NASA Task Load Index results indicated that the work overhead on the nurses was low. In fact, most of the burden measures were consistent with zero. The only potentially significant burden was temporal demand, which was consistent with the primary use case of the tool.
The evaluation indicates that the design was functional and met the requirements demanded by the nurses’ tight schedules and heavy workloads. The user interface embedded in the tool provided compelling utility tothe nurse with minimal distraction
The authors were to deploy the CDSS in 17 acute and long care facilities in a 3year clinical deployment. The clinical outcome measures (direct measurement of FTR cases and preventable complications) at the deployment sites will provide the validation of the efficacy of the tool in improving patient safety and hospital care.It will be interesting to assess the results of this full scale implementation of this CDSS and see if it supports the theory and reasoning behind the design of this CDSS.
- Yuan, M. J., Finley, G. M., Long, J., Mills, C., & Johnson, R. K. (2013). Evaluation of User Interface and Workflow Design of a Bedside Nursing Clinical Decision Support System. Interactive Journal of Medical Research, 2(1), e4. doi:10.2196/ijmr.2402 http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pmc/articles/PMC3628119/
- Reed K, May R. HealthGrades. 2011. Mar, .HealthGrades Patient Safety in American Hospitals Study https://www.cpmhealthgrades.com/CPM/assets/File/HealthGradesPatientSafetyInAmericanHospitalsStudy20 11.pdf.