Use of artificial intelligence in healthcare, such as machine learning-based predictive algorithms, holds promise for advancing outcomes, but few systems are used in routine clinical practice. Trust has been cited as an important challenge to meaningful use of artificial intelligence in clinical practice. Artificial intelligence systems often involve automating cognitively challenging tasks. Therefore, previous literature on trust in automation may hold important lessons for artificial intelligence applications in healthcare. In this perspective, we argue that informatics should take lessons from literature on trust in automation such that the goal should be to foster appropriate trust in artificial intelligence based on the purpose of the tool, its process for making recommendations, and its performance in the given context. We adapt a conceptual model to support this argument and present recommendations for future work.
Background Medication safety presents an ongoing challenge for nurses working in complex, fast-paced, intensive care unit (ICU) environments. Studying ICU nurse's medication management—especially medication-related events (MREs)—provides an approach to analyze and improve medication safety and quality. Objectives The goal of this study was to explore the utility of facilitated MRE reporting in identifying system deficiencies, and the relationship between MREs and nurses' work in the ICUs. Methods We conducted 124 structured four-hour observations of nurses in three different ICUs. Each observation included measurement of nurse's moment-to-moment activity and self-reports of workload and negative mood. The observer then obtained MRE reports from the nurse using a structured tool. The MREs were analyzed by three experts. Results MREs were reported in 35% of observations. The 60 total MREs included four medication errors and seven adverse drug events. Of the 49 remaining MREs, 65% were associated with negative patient impact. Task/process deficiencies were the most common contributory factor for MREs. MRE occurrence was correlated with increased total task volume. MREs also correlated with increased workload, especially during night shifts. Discussion The majority of these MREs would not be captured by traditional event reporting systems. Facilitated MRE reporting provides a robust information source about potential breakdowns in medication management safety and opportunities for system improvement.
Background Electronic health record‐based clinical decision support (CDS) is a promising antibiotic stewardship strategy. Few studies have evaluated the effectiveness of antibiotic CDS in the pediatric emergency department (ED). Objective To compare the effectiveness of antibiotic CDS vs. usual care for promoting guideline‐concordant antibiotic prescribing for pneumonia in the pediatric ED. Design Pragmatic randomized clinical trial. Setting and Participants Encounters for children (6 months‐18 years) with pneumonia presenting to two tertiary care children s hospital EDs in the United States. Intervention CDS or usual care was randomly assigned during 4‐week periods within each site. The CDS intervention provided antibiotic recommendations tailored to each encounter and in accordance with national guidelines. Main Outcome and Measures The primary outcome was exclusive guideline‐concordant antibiotic prescribing within the first 24 h of care. Safety outcomes included time to first antibiotic order, encounter length of stay, delayed intensive care, and 3‐ and 7‐day revisits. Results 1027 encounters were included, encompassing 478 randomized to usual care and 549 to CDS. Exclusive guideline‐concordant prescribing did not differ at 24 h (CDS, 51.7% vs. usual care, 53.3%; odds ratio [OR] 0.94 [95% confidence interval [CI]: 0.73, 1.20]). In pre‐specified stratified analyses, CDS was associated with guideline‐concordant prescribing among encounters discharged from the ED (74.9% vs. 66.0%; OR 1.53 [95% CI: 1.01, 2.33]), but not among hospitalized encounters. Mean time to first antibiotic was shorter in the CDS group (3.0 vs 3.4 h; p = .024). There were no differences in safety outcomes. Conclusions Effectiveness of ED‐based antibiotic CDS was greatest among those discharged from the ED. Longitudinal interventions designed to target both ED and inpatient clinicians and to address common implementation challenges may enhance the effectiveness of CDS as a stewardship tool.
Context-specific descriptions of the intended user interactions with health information technology (HIT) systems provide an important perspective to the overall goals of HIT design. These descriptions — or scenarios — that represent the clinicians’ perspectives can describe how HIT should support users in providing patient care effectively, efficiently, and safely. Scenarios may improve the design of HIT systems by ensuring clinician needs are well-articulated for high-value patient-care situations. This Practice- Oriented paper presents suggestions for the development and application of clinical scenarios throughout a robust user-centered design (UCD) process. As a flexible artifact, different types of scenarios can be used at each point across the UCD process and the rationale for their use are discussed, and we suggest key aspects that must be included for each specific type of scenario. This practice innovation will be beneficial to practitioners working within UCD processes, as guidance on adding scenarios as a tool in their work.
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