User-Centered Collaborative Design and Development of an Inpatient Safety Dashboard

Mlaver, Eli; Schnipper, Jeffrey L.; Boxer, Robert; Breuer, Dominic J.; Gershanik, Esteban; Dykes, Patricia C.; Massaro, Anthony F.; Benneyan, James C.; Bates, David W.; Lehmann, Lisa Soleymani

doi:10.1016/j.jcjq.2017.05.010

Cited by 34 publications

(47 citation statements)

References 19 publications

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“…(This figure has been adapted from: Mlaver E, Schnipper JL, Boxer R, et al User-centered collaborative design and development of an inpatient safety dashboard. J Comm J Qual Pat Saf 2017;43(12):676-685, 16 with permission from Elsevier).…”

Section: Methodsmentioning

confidence: 99%

“…In this study, we evaluated the implementation of a CDSS tool, a Patient Safety Dashboard, integrated within a vendor EHR. 16 The Dashboard accesses and consolidates real-time EHR data to assist clinicians in quickly assessing high-priority safety domains for patients admitted to the hospital. In this mixed-method evaluation, we report on actual use by providers, perceptions of its usability and effectiveness, and field observations on clinicians' use of the tool to provide lessons learned for the design and implementation of future tools of this type.…”

Section: Background and Significancementioning

confidence: 99%

“…The development, features, and functions of the Patient Safety Dashboard have been previously described. 16 Through iterative, user-centered design, the Dashboard sought to mitigate preventable harms by visualizing real-time EHR data to assist clinicians in assessing 13 safety domains: code status, glucose control, nutrition, bowel regimen, venous thromboembolism (VTE) prophylaxis, opioid management, antibiotic management, pressure ulcer prevention and management, delirium management, fall risk, vascular access, urinary catheter management, and telemetry. Two additional domains, discharge planning and patient expectations, were added to the Dashboard later in the study.…”

Section: Interventionmentioning

confidence: 99%

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Use, Perceived Usability, and Barriers to Implementation of a Patient Safety Dashboard Integrated within a Vendor EHR

et al. 2020

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Background Preventable adverse events continue to be a threat to hospitalized patients. Clinical decision support in the form of dashboards may improve compliance with evidence-based safety practices. However, limited research describes providers' experiences with dashboards integrated into vendor electronic health record (EHR) systems. Objective This study was aimed to describe providers' use and perceived usability of the Patient Safety Dashboard and discuss barriers and facilitators to implementation. Methods The Patient Safety Dashboard was implemented in a cluster-randomized stepped wedge trial on 12 units in neurology, oncology, and general medicine services over an 18-month period. Use of the Dashboard was tracked during the implementation period and analyzed in-depth for two 1-week periods to gather a detailed representation of use. Providers' perceptions of tool usability were measured using the Health Information Technology Usability Evaluation Scale (rated 1–5). Research assistants conducted field observations throughout the duration of the study to describe use and provide insight into tool adoption. Results The Dashboard was used 70% of days the tool was available, with use varying by role, service, and time of day. On general medicine units, nurses logged in throughout the day, with many logins occurring during morning rounds, when not rounding with the care team. Prescribers logged in typically before and after morning rounds. On neurology units, physician assistants accounted for most logins, accessing the Dashboard during daily brief interdisciplinary rounding sessions. Use on oncology units was rare. Satisfaction with the tool was highest for perceived ease of use, with attendings giving the highest rating (4.23). The overall lowest rating was for quality of work life, with nurses rating the tool lowest (2.88). Conclusion This mixed methods analysis provides insight into the use and usability of a dashboard tool integrated within a vendor EHR and can guide future improvements and more successful implementation of these types of tools.

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Section: Methodsmentioning

confidence: 99%

Section: Background and Significancementioning

confidence: 99%

Section: Interventionmentioning

confidence: 99%

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Use, Perceived Usability, and Barriers to Implementation of a Patient Safety Dashboard Integrated within a Vendor EHR

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“…7 During the evaluation process, many developers in the health care setting rely on practical tools to assess usability that take into consideration the time limitations of clinical users, including heuristic checklists, questionnaires, surveys, interviews, and focus groups. [8][9][10][11] While these can expose end user perceptions of usefulness, implementation feasibility, and satisfaction, a usability study involving real-time observation of users completing specified, typical tasks provides added insight into the quality of user interaction with a given application within the intended setting. 12,13 The Veterans Affairs' (VA) primary care workforce development project, the Geriatric Scholars Program (GSP), supports the integration of geriatrics into primary care.…”

Section: Background and Significancementioning

confidence: 99%

Usability Testing a Potentially Inappropriate Medication Dashboard: A Core Component of the Dashboard Development Process

et al. 2020

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Background With the increased usage of dashboard reporting systems to monitor and track patient panels by clinical users, developers must ensure that the information displays they produce are accurate and intuitive. When evaluating usability of a clinical dashboard among potential end users, developers oftentimes rely on methods such as questionnaires as opposed to other, more time-intensive strategies that incorporate direct observation. Objectives Prior to release of the potentially inappropriate medication (PIM) clinical dashboard, designed to facilitate completion of a quality improvement project by clinician scholars enrolled in the Veterans Affairs (VA) workforce development Geriatric Scholars Program (GSP), we evaluated the usability of the system. This article describes the process of usability testing a dashboard reporting system with clinicians using direct observation and think-aloud moderating techniques. Methods We developed a structured interview protocol that combines virtual observation, think-aloud moderating techniques, and retrospective questioning of the overall user experience, including use of the System Usability Scale (SUS). Thematic analysis was used to analyze field notes from the interviews of three GSP alumni. Results Our structured approach to usability testing identified specific functional problems with the dashboard reporting system that were missed by results from the SUS. Usability testing lead to overall improvements in the intuitive use of the system, increased data transparency, and clarification of the dashboard's purpose. Conclusion Reliance solely on questionnaires and surveys at the end stages of dashboard development can mask potential functional problems that will impede proper usage and lead to misinterpretation of results. A structured approach to usability testing in the developmental phase is an important tool for developers of clinician friendly systems for displaying easily digested information and tracking outcomes for the purpose of quality improvement.

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“…While relatively new programs, results-to-date provide further evidence of the value of partnering healthcare and HF/SE researchers. (18, 53) However, such opportunities are a minority and greater funding is needed, especially given the size and scope of the healthcare industry and patient safety issues.…”

Section: Introductionmentioning

confidence: 99%

Challenges And Opportunities For Improving Patient Safety Through Human Factors And Systems Engineering

et al. 2018

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Despite progress on patient safety since the Institute of Medicine 1999 report “To Err is Human”, significant problems remain. Human factors and systems engineering (HF/SE) has been increasingly recognized and advocated for its value in understanding, improving, and redesigning processes for safer care, especially for complex interacting sociotechnical systems. Broad awareness and adoption of HF/SE into safety improvement work, however, has been frustratingly slow. We provide an overview of HF/SE, its demonstrated value to a wide range of patient safety problems, in particular medication safety, and challenges to its broader implementation across health care. We propose seven recommendations and policy implications to maximize the spread of HF/SE, including formal and informal education programs, greater adoption of HF/SE by healthcare organizations, expanded funding to foster greater clinician-engineer partnerships, and coordinated national efforts to design and operationalize a system for spreading HF/SE into health care nationally.

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User-Centered Collaborative Design and Development of an Inpatient Safety Dashboard

Cited by 34 publications

References 19 publications

Use, Perceived Usability, and Barriers to Implementation of a Patient Safety Dashboard Integrated within a Vendor EHR

Use, Perceived Usability, and Barriers to Implementation of a Patient Safety Dashboard Integrated within a Vendor EHR

Usability Testing a Potentially Inappropriate Medication Dashboard: A Core Component of the Dashboard Development Process

Challenges And Opportunities For Improving Patient Safety Through Human Factors And Systems Engineering

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