Bridging the feedback gap: a sociotechnical approach to informing clinicians of patients’ subsequent clinical course and outcomes

Cifra, Christina L.; Sittig, Dean F.; Singh, Hardeep

doi:10.1136/bmjqs-2020-012464

Cited by 15 publications

(19 citation statements)

References 23 publications

(29 reference statements)

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“…Commonly used EHR platforms, such as Epic, have existing functionality, such as the ability to insert patient data into templated letters 15 16 that can automate steps in the feedback process and can be readily adapted for implementation. 17…”

Section: Methodsmentioning

confidence: 99%

“…Commonly used EHR platforms, such as Epic, have existing functionality, such as the ability to insert patient data into templated letters 15,16 that can automate steps in the feedback process and can be readily adapted for implementation. 17 We used a human factors engineering approach as applied to biomedical informatics projects to develop and test the EHRsupported feedback process. This approach uses a functional model of a human factors engineering lifecycle adapted for health care work situations and incorporates usability engineering methods to evaluate health care products and workflows.…”

Section: Development and Evaluation Of The Feedback System Using A Hu...mentioning

confidence: 99%

“…This approach uses a functional model of a human factors engineering lifecycle adapted for health care work situations and incorporates usability engineering methods to evaluate health care products and workflows. 18 Throughout development, we were guided by the Health Information Technology Safety Framework 14,17 which provides a multidimensional sociotechnical approach for evaluating and ensuring safety of health IT in complex adaptive health care settings. This approach accounts for important interactions among clinicians, tasks/workflows, and technology that may present as facilitators or barriers to implementation.…”

Section: Development and Evaluation Of The Feedback System Using A Hu...mentioning

confidence: 99%

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Reporting Outcomes of Pediatric Intensive Care Unit Patients to Referring Physicians via an Electronic Health Record-Based Feedback System

et al. 2022

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Background Many critically ill children are initially evaluated in front-line settings by clinicians with variable pediatric training before they are transferred to a pediatric intensive care unit (PICU). Because clinicians learn from past performance, communicating outcomes of patients back to front-line clinicians who provide pediatric emergency care could be valuable; however, referring clinicians do not consistently receive this important feedback. Objectives Our aim was to determine the feasibility, usability, and clinical relevance of a semiautomated electronic health record (EHR)-supported system developed at a single institution to deliver timely and relevant PICU patient outcome feedback to referring emergency department (ED) physicians. Methods Guided by the Health Information Technology Safety Framework, we iteratively designed, implemented, and evaluated a semiautomated electronic feedback system leveraging the EHR in one institution. After conducting interviews and focus groups with stakeholders to understand the PICU-ED health care work system, we designed the EHR-supported feedback system by translating stakeholder, organizational, and usability objectives into feedback process and report requirements. Over 6 months, we completed three cycles of implementation and evaluation, wherein we analyzed EHR access logs, reviewed feedback reports sent, performed usability testing, and conducted physician interviews to determine the system's feasibility, usability, and clinical relevance. Results The EHR-supported feedback process is feasible with timely delivery and receipt of feedback reports. Usability testing revealed excellent Systems Usability Scale scores. According to physicians, the process was well-integrated into their clinical workflows and conferred minimal additional workload. Physicians also indicated that delivering and receiving consistent feedback was relevant to their clinical practice. Conclusion An EHR-supported system to deliver timely and relevant PICU patient outcome feedback to referring ED physicians was feasible, usable, and important to physicians. Future work is needed to evaluate impact on clinical practice and patient outcomes and to investigate applicability to other clinical settings involved in similar care transitions.

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Section: Methodsmentioning

confidence: 99%

Section: Development and Evaluation Of The Feedback System Using A Hu...mentioning

confidence: 99%

Section: Development and Evaluation Of The Feedback System Using A Hu...mentioning

confidence: 99%

See 1 more Smart Citation

Reporting Outcomes of Pediatric Intensive Care Unit Patients to Referring Physicians via an Electronic Health Record-Based Feedback System

et al. 2022

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“…First, we suggest tracking patients’ clinical outcomes by creating an electronic list of patients where the diagnosis is still evolving or questions remain, setting reminders to check diagnostic outcomes, and creating a log of lessons learnt 31. Second, we recommend clinicians learn through feedback on their diagnostic outcomes from other health professionals, patients, and families 32. This feedback can be a brief communication about a patient’s final diagnosis or outcome (“I have an update on that patient you saw”) or a conversation that highlights opportunities to improve diagnostic performance and reinforces practices that lead to diagnostic excellence 33.…”

Section: Five Strategies For Diagnostic Excellencementioning

confidence: 99%

Five strategies for clinicians to advance diagnostic excellence

Singh¹,

Connor

Dhaliwal

2022

BMJ

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“…Missed follow-up of test results occurs due to several sociotechnical factors [15]; interventions to deliver feedback to improve test result follow-up also need to be sociotechnical [16]. We used participatory methods involving clinicians, including co-design workshops, to identify possible interventions to deliver feedback that could improve follow-up of test results in VA primary care.…”

Section: Application To a Health Services Problem: Case Studymentioning

confidence: 99%

Electronic Co-design (ECO-design) Workshop for Increasing Clinician Participation in the Design of Health Services Interventions: Participatory Design Approach

Savoy¹,

Patel²,

Shahid³

et al. 2022

JMIR Hum Factors

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Background Participation from clinician stakeholders can improve the design and implementation of health care interventions. Participatory design methods, especially co-design methods, comprise stakeholder-led design activities that are time-consuming. Competing work demands and increasing workloads make clinicians’ commitments to typical participatory methods even harder. The COVID-19 pandemic further exacerbated barriers to clinician participation in such interventions. Objective The aim of this study was to explore a web-based participatory design approach to conduct economical, electronic co-design (ECO-design) workshops with primary care clinicians. Methods We adapted traditional in-person co-design workshops to web-based delivery and adapted co-design workshop series to fit within a single 1-hour session. We applied the ECO-design workshop approach to codevelop feedback interventions regarding abnormal test result follow-up in primary care. We conducted ECO-design workshops with primary care clinicians at a medical center in Southern Texas, using videoconferencing software. Each workshop focused on one of three types of feedback interventions: conversation guide, email template, and dashboard prototype. We paired electronic materials and software features to facilitate participant interactions, prototyping, and data collection. The workshop protocol included four main activities: problem identification, solution generation, prototyping, and debriefing. Two facilitators were assigned to each workshop and one researcher resolved technical problems. After the workshops, our research team met to debrief and evaluate workshops. Results A total of 28 primary care clinicians participated in our ECO-design workshops. We completed 4 parallel workshops, each with 5-10 participants. We conducted traditional analyses and generated a clinician persona (ie, representative description) and user interface prototypes. We also formulated recommendations for future ECO-design workshop recruitment, technology, facilitation, and data collection. Overall, our adapted workshops successfully enabled primary care clinicians to participate without increasing their workload, even during a pandemic. Conclusions ECO-design workshops are viable, economical alternatives to traditional approaches. This approach fills a need for efficient methods to involve busy clinicians in the design of health care interventions.

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Bridging the feedback gap: a sociotechnical approach to informing clinicians of patients’ subsequent clinical course and outcomes

Cited by 15 publications

References 23 publications

Reporting Outcomes of Pediatric Intensive Care Unit Patients to Referring Physicians via an Electronic Health Record-Based Feedback System

Reporting Outcomes of Pediatric Intensive Care Unit Patients to Referring Physicians via an Electronic Health Record-Based Feedback System

Five strategies for clinicians to advance diagnostic excellence

Electronic Co-design (ECO-design) Workshop for Increasing Clinician Participation in the Design of Health Services Interventions: Participatory Design Approach

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