Informatics and interaction: Applying human factors principles to optimize the design of clinical decision support for sepsis

Abstract

In caring for patients with sepsis, the current structure of electronic health record systems allows clinical providers access to raw patient data without imputation of its significance. There are a wide range of sepsis alerts in clinical care that act as clinical decision support tools to assist in early recognition of sepsis; however, there are serious shortcomings in existing health information technology for alerting providers in a meaningful way. Little work has been done to evaluate and assess existing alerts using implementation and process outcomes associated with health information technology displays, specifically evaluating clinician preference and performance. We developed graphical model displays of two popular sepsis scoring systems, quick Sepsis Related Organ Failure Assessment and Predisposition, Infection, Response, Organ Failure, using human factors principles grounded in user-centered and interaction design. Models will be evaluated in a larger research effort to optimize alert design to improve the collective awareness of high-risk populations and develop a relevant point-of-care clinical decision support system for sepsis.

Desired Characteristics of a Clinical Decision Support System for Early Sepsis Recognition: Interview Study Among Hospital-Based Clinicians

“…Our participants desired an easy-to-digest alert that was, most importantly, accessible, unobtrusive, and believed to be clinically accurate. The acceptability of sepsis CDS relies on both its prediction accuracy and its presentation of information in a readily interpretable manner [ 28 ]. There is a growing body of evidence investigating the importance of human factors in CDS design, ranging from alert type to textual and graphical displays of information [ 25 , 28 ].…”

“…The acceptability of sepsis CDS relies on both its prediction accuracy and its presentation of information in a readily interpretable manner [ 28 ]. There is a growing body of evidence investigating the importance of human factors in CDS design, ranging from alert type to textual and graphical displays of information [ 25 , 28 ]. Clinicians made numerous suggestions along these lines, including displaying a “flag” or marker in the “summary” tab of a patient’s chart to assist the clinician in recognizing an issue without interrupting usual workflows.…”

Improving the care of term babies at risk of hypoglycaemia: A microsystem approach

“…In the best examples, successful CDSSs reduce medical errors, increase health‐care quality and efficiency and guide appropriate care decisions 7 . However, time pressures, competing demands and ambiguous alert designs can reduce a user's opportunity to detect signals in the face of ‘noise’ and may lead to inadvertent confirmation bias 5 …”

“…7 However, time pressures, competing demands and ambiguous alert designs can reduce a user's opportunity to detect signals in the face of 'noise' and may lead to inadvertent confirmation bias. 5 We wanted to ensure our tool was designed in a way to maximise user acceptance, avoid alert 'fatigue' and additionally lead to improved outcomes without increasing the workload. The purpose of the tool was to signal important issues and guide the provider based on human factor principles.…”

“…The clinical support tool was inspired by the traffic light system used in the RHINO project 4 . The flow chart was designed using human factors best practice recommendations for the design of clinical reminders 5 including: Physical organisation: Our tool was a one‐page flow chart, which was incorporated into the BGC observation chart. Visual cues and consistency: Depending on the level of the initial BGC, the baby would fall under either a red, amber or green pathway. Clean and concise: We ensured that the information given in the chart was not ambiguous and was presented in a clean and concise manner by standardising the terminology. …”