Pilot testing of a new electronic diagnostic support tool (AiD-DST) designed to identify the cause(s) of delirium

Abstract

Introduction Delirium is frequently multifactorial, and causes are often missed in clinical practice. The Aetiology in Delirium - Diagnostic Support Tool (AiD-DST) was developed to improve recognition of the causes. We undertook an evaluation of an electronic version of AiD-DST. Methods A development and evaluation life cycle of improvement was used. In phase 1, alpha testing among the development group evaluated technical performance of AiD-DST. In phase 2, we performed a cycle of beta testing among junior doctors to assess impressions of AiD-DST using Think Aloud methodology. We grouped responses into themes and made changes to AiD-DST by the development group accordingly. In phase 3, usability and acceptance of AiD-DST was assessed using the mHealth App Usability Questionnaire (MAUQ). Results In phase 1, software issues were identified, and modifications made. In phase 2, feedback was obtained from 29 junior doctors. Three cycles of feedback were obtained. The number of items identified after each cycle were 20, 12 and 7, respectively. Content was grouped into themes of; ‘style and grammar’, ‘formatting’, ‘IT’, ‘missed diagnosis’ and ‘other concerns.’ In phase 3, 20 participants completed MAUQ questionnaire. Overall, the average score was 6.36 (SD=0.8) with 7 as the highest attainable score. This translates to agreement up to strong agreement concerning usability of AiD-DST. Conclusion After a process of optimisation, AiD-DST has been shown to be a usable and potentially useful diagnostic support tool to help junior doctors identify cause(s) of delirium. An implementation study is planned.

Face and content validity of a mobile delirium screening tool adapted for use in the medical setting (eDIS‐MED): Welcome to the machine

“…The commonly experienced adverse outcomes in what is usually a frail population, including severe dementia, makes clinical research a potentially significant burden 13 . Despite this limitation, it should be acknowledged that consumer engagement has been sought in earlier phases of development of the original tool 1,3 …”

“…13 Despite this limitation, it should be acknowledged that consumer engagement has been sought in earlier phases of development of the original tool. 1,3 The revised pictorial questions are currently being reviewed against Color Universal Design principles and some changes in the semantics of in-app diagnosis are being eveluated. 14 In the optimised form, clinical testing is anticipated.…”

“…2 A process of redesign to enhance functionality for the medical context has led to evolution of eDIS-ICU into eDIS-MED. 3 However, suitability of eDIS-MED content to patients with delirium in a medical environment remains unclear. While the diagnostic features of delirium are common to all settings, the demographics, phenomenology and aetiologies between patients in an intensive care and medicine environment are different.…”

“…Instrument construction and preliminary testing in the intensive care setting has been described previously with proof of principle demonstrated 2 . A process of redesign to enhance functionality for the medical context has led to evolution of eDIS‐ICU into eDIS‐MED 3 . However, suitability of eDIS‐MED content to patients with delirium in a medical environment remains unclear.…”