Dashboard Design to Identify and Balance Competing Risk of Multiple Hospital-Acquired Conditions

Abstract

Background Hospital-acquired conditions (HACs) are common, costly, and national patient safety priority. Catheter-associated urinary tract infections (CAUTIs), hospital-acquired pressure injury (HAPI), and falls are common HACs. Clinicians assess each HAC risk independent of other conditions. Prevention strategies often focus on the reduction of a single HAC rather than considering how actions to prevent one condition could have unintended consequences for another HAC. Objectives The objective of this study is to design an empirical framework to identify, assess, and quantify the risks of multiple HACs (MHACs) related to competing single-HAC interventions. Methods This study was an Institutional Review Board approved, and the proof of concept study evaluated MHAC Competing Risk Dashboard to enhance clinicians' management combining the risks of CAUTI, HAPI, and falls. The empirical model informing this study focused on the removal of an indwelling urinary catheter to reduce CAUTI, which may impact HAPI and falls. A multisite database was developed to understand and quantify competing risks of HACs; a predictive model dashboard was designed and clinical utility of a high-fidelity dashboard was qualitatively tested. Five hospital systems provided data for the predictive model prototype; three served as sites for testing and feedback on the dashboard design and usefulness. The participatory study design involved think-aloud methods as the clinician explored the dashboard. Individual interviews provided an understanding of clinician's perspective regarding ease of use and utility. Results Twenty-five clinicians were interviewed. Clinicians favored a dashboard gauge design composed of green, yellow, and red segments to depict MHAC risk associated with the removal of an indwelling urinary catheter to reduce CAUTI and possible adverse effects on HAPI and falls. Conclusion Participants endorsed the utility of a visual dashboard guiding clinical decisions for MHAC risks preferring common stoplight color understanding. Clinicians did not want mandatory alerts for tool integration into the electronic health record. More research is needed to understand MHAC and tools to guide clinician decisions.

Centralized Multipatient Dashboards' Impact on Intensive Care Unit Clinician Performance and Satisfaction: A Systematic Review

“…39,40 This approach contrasts with information being fragmented among multiple pages in the EMR. 39,40 Additionally, such tools can be particularly powerful when representing dynamic time frame data. For instance, an e-antibiogram, generated and regularly updated from both laboratory and pharmacy data, presents a viable alternative to the static, manually compiled antibiogram typically produced annually.…”

“…38 Makic et al and Zaydfudim et al suggested that dashboards have the potential to help clinicians address overlapping risks and potential patient harm in the unit by managing multiple values for preidentified health care-associated infection risk. 39 40 This approach contrasts with information being fragmented among multiple pages in the EMR. 39 40 Additionally, such tools can be particularly powerful when representing dynamic time frame data.…”

“…managing multiple values for preidentified healthcare-associated infection risk [39], [40] . This approach contrasts with information being fragmented among multiple pages in the EMR [39], [40] .…”

Understanding the perceived role of electronic health records and workflow fragmentation on clinician documentation burden in emergency departments

“…According to participants, workflow fragmentation originated from physical disruptions by colleagues, inadequate computer peripherals (eg, single computer screen), and the EHR software (eg, interruptive alerts, display, and task fragmentation 47 ). Described elsewhere in the literature as a cause of EHR cognitive burden, 63 display fragmentation 47 (ie, the need to click through several screens and views due to disjoint information), and task fragmentation 47 (ie, “undesirable” separation of task components) in the EHR was reported as a design flaw and key driver of task switching among participants. Moreover, clinicians perceived that reimbursement, regulatory, and reporting requirements not only fragmented clinician documentation workflows but also resulted in poor documentation quality as it splintered the patient’s narrative.…”

Developing the VA Geriatric Scholars Programs' Clinical Dashboards Using the PDSA Framework for Quality Improvement

“…These studies report on dashboard performance as measured by end user uptake, usability, or associated improvement in health outcomes, with some detail provided on which factors in their development process were believed to contribute to the dashboard's successes. 7 8 9 10 11 12 There is growing consensus that involving clinicians in the development process of audit and feedback clinical dashboards is important to ensure that user needs are adequately met prior to releasing the dashboard for routine use, subsequently improving uptake and adoption. 13 14 This principle has long been understood in the field of human-centered design, which seeks to systematically integrate end-user feedback throughout the development process.…”