Workflow integration analysis of a human factors-based clinical decision support in the emergency department

Salwei, Megan E.; Carayon, Pascale; Hoonakker, Peter; Hundt, Ann Schoofs; Wiegmann, Douglas A.; Pulia, Michael S.; Patterson, Brian W.

doi:10.1016/j.apergo.2021.103498

Cited by 36 publications

(36 citation statements)

References 44 publications

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“…Since the involvement of human factors engineers in the design of these systems, aviation has become the safest mode of transportation. Beyond aviation, human factors engineering methods have been applied to the design of complex systems in other domains, including ground transportation,3 the military,4 nuclear process control5 and healthcare 6 7…”

Section: Introductionmentioning

confidence: 99%

“…Decision support systems have the potential to support the user making better decisions and reduce decision errors. For example, clinical decision support tools have the potential in improving patient safety by improving the clinician’s diagnostic decisions 6 7. However, the success of decision support tools in clinical settings has been limited, in part due to human factors such as poor usability and workflow integration 8–11.…”

Section: Introductionmentioning

confidence: 99%

“…While human factors methods have been applied to the design of decision support tools to aid clinicians in decision-making tasks in healthcare settings,6 7 applications of human factors to support public health professionals in improving population health outcomes are limited. Population health can be defined as ‘the health outcomes of a group of individuals, including the distribution of such outcomes within the group’ 12.…”

Section: Introductionmentioning

confidence: 99%

“…Beyond aviation, human factors engineering methods have been applied to the design of complex systems in other domains, including ground transportation, 3 the military, 4 nuclear process control 5 and healthcare. 6 7 …”

Section: Introductionmentioning

confidence: 99%

“…For example, clinical decision support tools have the potential in improving patient safety by improving the clinician’s diagnostic decisions. 6 7 However, the success of decision support tools in clinical settings has been limited, in part due to human factors such as poor usability and workflow integration. 8–11 Indeed, if human factors perspectives are not considered in their design (eg, how people make decisions, their expertise, their information needs), users may not leverage the tool.…”

Section: Introductionmentioning

confidence: 99%

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Human factors applications in the design of decision support systems for population health: a scoping review

et al. 2022

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IntroductionPublic health professionals engage in complex cognitive tasks, often using evidence-based decision support tools to bolster their decision-making. Human factors methods take a user-centred approach to improve the design of systems, processes, and interfaces to better support planning and decision-making. While human factors methods have been applied to the design of clinical health tools, these methods are limited in the design of tools for population health. The objective of this scoping review is to develop a comprehensive understanding of how human factors techniques have been applied in the design of population health decision support tools.Methods and analysisThe scoping review will follow the methodology and framework proposed by Arksey and O’Malley. We include English-language documents between January 1990 and August 2021 describing the development, validation or application of human factors principles to decision support tools in population health. The search will include Ovid MEDLINE: Epub Ahead of Print, In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily and Ovid MEDLINE 1946–present; EMBASE, Scopus, PsycINFO, Compendex, IEEE Xplore and Inspec. The results will be integrated into Covidence. First, the abstract of all identified articles will be screened independently by two reviewers with disagreements being resolved by a third reviewer. Next, the full text for articles identified as include or inconclusive will be reviewed by two independent reviewers, leading to a final decision regarding inclusion. Reference lists of included articles will be manually screened to identify additional studies. Data will be extracted by one reviewer, verified by a second, and presented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews.Ethics and disseminationEthics approval is not required for this work as human participants are not involved. The completed review will be published in a peer-reviewed, interdisciplinary journal.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Human factors applications in the design of decision support systems for population health: a scoping review

et al. 2022

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Physicians’ Perceptions of Clinical Decision Support to Treat Patients With Heart Failure in the ED

Casey,

Reed,

LeMaster

et al. 2023

JAMA Netw Open

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ImportanceClinical decision support (CDS) could help emergency department (ED) physicians treat patients with heart failure (HF) by estimating risk, collating relevant history, and assisting with medication prescribing if physicians’ perspectives inform its design and implementation.ObjectiveTo evaluate CDS usability and workflow integration in the hands of ED physician end users who use it in clinical practice.Design, Setting, and ParticipantsThis mixed-methods qualitative study administered semistructured interviews to ED physicians from 2 community EDs of Kaiser Permanente Northern California in 2023. The interview guide, based on the Usability Heuristics for User Interface Design and the Sociotechnical Environment models, yielded themes used to construct an electronic survey instrument sent to all ED physicians.Main Outcomes and MeasuresMain outcomes were physicians’ perceptions of using CDS to complement clinical decision-making, usability, and integration into ED clinical workflow.ResultsSeven key informant physicians (5 [71.4%] female, median [IQR] 15.0 [9.5-15.0] years in practice) were interviewed and survey responses from 51 physicians (23 [45.1%] female, median [IQR] 14.0 [9.5-17.0] years in practice) were received from EDs piloting the CDS intervention. Response rate was 67.1% (51 of 76). Physicians suggested changes to CDS accessibility, functionality, and workflow integration. Most agreed that CDS would improve patient care and fewer than half of physicians expressed hesitation about their capacity to consistently comply with its recommendations, citing workload concerns. Physicians preferred a passive prompt that encouraged, but did not mandate, interaction with the CDS.Conclusions and RelevanceIn this qualitative study of physicians who were using a novel CDS intervention to assist with ED management of patients with acute HF, several opportunities were identified to improve usability as well as several key barriers and facilitators to CDS implementation.

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Cognitive Biases and Mitigation Strategies in Emergency Diagnosis

Bedolla

Pines

2023

Evidence‐Based Emergency Care

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Workflow integration analysis of a human factors-based clinical decision support in the emergency department

Cited by 36 publications

References 44 publications

Human factors applications in the design of decision support systems for population health: a scoping review

Human factors applications in the design of decision support systems for population health: a scoping review

Physicians’ Perceptions of Clinical Decision Support to Treat Patients With Heart Failure in the ED

Cognitive Biases and Mitigation Strategies in Emergency Diagnosis

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