Human-centered design of team health IT for pediatric trauma care transitions

Carayon, Pascale; Hose, Bat‐Zion; Wooldridge, Abigail R.; Brazelton, Tom; Dean, Shannon M.; Eithun, Benjamin; Kelly, Michelle M.; Kohler, Jonathan E.; Ross, Joshua; Rusy, Deborah A.; Hoonakker, Peter

doi:10.1016/j.ijmedinf.2022.104727

Cited by 10 publications

(9 citation statements)

References 35 publications

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“…Overall, to effectively implement a risk assessment tool for pediatric cervical spine imaging, guidelines should be co‐developed and introduced to collaboratively by both emergency and trauma physicians 22 . This will help to ensure that guidelines reflect priorities from both specialties and demonstrate to each specialty that the tool is supported by their respective groups.…”

Section: Discussionmentioning

confidence: 99%

Decision‐making for pediatric cervical spine imaging after blunt trauma: Investigating team dynamics in the emergency department

Gregory,

Truelove,

Ahmad

et al. 2023

JACEP Open

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ObjectiveCervical spine imaging decision‐making for pediatric traumas is complex and multidisciplinary. Implementing a risk assessment tool has the potential to reduce variation in these decisions and unnecessary radiation exposure for pediatric patients. We sought to determine how emergency department–trauma team dynamics may affect implementation of such a tool.MethodsWe interviewed (pediatric and general emergency physicians, trauma surgeons, neurosurgeons, orthopedic surgeons and ED nurses at 21 hospitals to ascertain how team dynamics affect the pediatric cervical spine imaging decision‐making process. Data were coded following a framework‐driven deductive coding process and thematic analysis was used.ResultsForty‐eight physicians, advanced practice providers, and nurses from 21 hospitals (inclusive of three US regions, trauma levels I–III, and serving towns/cities of various population sizes) were interviewed. Overall, emergency physicians and trauma surgeons indicate being generally responsible for pediatric cervical spine imaging decisions. Conflict often occurs between these specialties due to differential weighting of concerns for missing an injury versus avoiding radiation exposure. Participants described a lack of trust and unclear roles regarding ownership for the final imaging decision. Nurses commonly described low psychological safety that prohibits them from participating in the decision‐making process.ConclusionsImplementation of a standardized risk assessment tool for cervical spine trauma imaging decisions must consider perspectives of both emergency medicine and trauma. Policies to define appropriate use of standardized tools within this team environment should be developed.

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Section: Discussionmentioning

confidence: 99%

Decision‐making for pediatric cervical spine imaging after blunt trauma: Investigating team dynamics in the emergency department

Gregory,

Truelove,

Ahmad

et al. 2023

JACEP Open

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“…Sung et al [26] suggest that internal HIT factors and external human factors at the organizational level both influence HIT implementation and it is important to understand both these perspectives. An organizational-level EHR strategy supports an understanding of evolving needs and sentiments of clinicians as a precursor to mitigating issues such as burnout [53]. Similarly, a Physician Engagement Strategy with four components: engage, inspire, change, and measure was developed to reduce the burden of EHR use on physicians [28].…”

Section: Mesomentioning

confidence: 99%

“…When HIT fails to adequately support teamwork we see workarounds or manual processes such as for data transfer or other tasks, which leads to a significant administrative burden on clinical teams [50]. While we often transition or scale processes from the micro to the meso level [49,53], we can also use blended approaches that start at the team or organizational level and then scale down to individuals [25,49].…”

Section: Mesomentioning

confidence: 99%

“…ODH will only be as successful as how we engage with users of all types including patients, providers, and administrators in the heath sector and similar users in the environmental and veterinary sectors. Some of the surveyed papers provided examples of engagement strategies [28,53] and we should look to these as a starting point for engagement strategies while expanding and scaling where need be.…”

Section: Enabling and Monitoring Systemmentioning

confidence: 99%

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The Role of Human and Organizational Factors in the Pursuit of One Digital Health

Kuziemsky

2023

Yearb Med Inform

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Objective: This paper surveys a subset of the 2022 human and organizational factor (HOF) literature to provide guidance on building a One Digital Health ecosystem. Methods: We searched a subset of journals in PubMed/Medline for studies with „human factors“ or „organization“ in the title or abstract. Papers published in 2022 were eligible for inclusion in the survey. Selected papers were categorized into structural and behavioural aspects to understand digital health enabled interactions across micro, meso, and macro systems. Results: Our survey of the 2022 HOF literature showed that while we continue to make meaningful progress at digital health enabled interactions across systems levels, there are still challenges that must be overcome. For example, we must continue to grow the breadth of HOF research beyond individual users and systems to assist with the scale up of digital health systems across and beyond organizations. We summarize the findings by providing five HOF considerations to help build a One Digital Health ecosystem. Conclusion: One Digital Health challenges us to improve coordination, communication, and collaboration between the health, environmental and veterinary sectors. Doing so requires us to develop both the structural and behavioural capacity of digital health systems at the organizational level and beyond so that we can develop more robust and integrated systems across health, environmental and veterinary sectors. The HOF community has much to offer and must play a leading role in designing a One Digital Health ecosystem.

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“…One way to address this is by clearly defining an aim, for example, design a patient-centered discharge process, that can guide the integration and prioritization of perspectives in a design team with representation from multiple stakeholders. HFE methods such as participatory design and co-design offer frameworks for doing this [21][22][23][24].…”

Section: Overviewmentioning

confidence: 99%

Evaluating the Usability of an Emergency Department After Visit Summary: Staged Heuristic Evaluation

Barton¹,

Salwei²,

Rutkowski³

et al. 2023

JMIR Hum Factors

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Background Heuristic evaluations, while commonly used, may inadequately capture the severity of identified usability issues. In the domain of health care, usability issues can pose different levels of risk to patients. Incorporating diverse expertise (eg, clinical and patient) in the heuristic evaluation process can help assess and address potential negative impacts on patient safety that may otherwise go unnoticed. One document that should be highly usable for patients—with the potential to prevent adverse outcomes—is the after visit summary (AVS). The AVS is the document given to a patient upon discharge from the emergency department (ED), which contains instructions on how to manage symptoms, medications, and follow-up care. Objective This study aims to assess a multistage method for integrating diverse expertise (ie, clinical, an older adult care partner, and health IT) with human factors engineering (HFE) expertise in the usability evaluation of the patient-facing ED AVS. Methods We conducted a three-staged heuristic evaluation of an ED AVS using heuristics developed for use in evaluating patient-facing documentation. In stage 1, HFE experts reviewed the AVS to identify usability issues. In stage 2, 6 experts of varying expertise (ie, emergency medicine physicians, ED nurses, geriatricians, transitional care nurses, and an older adult care partner) rated each previously identified usability issue on its potential impact on patient comprehension and patient safety. Finally, in stage 3, an IT expert reviewed each usability issue to identify the likelihood of successfully addressing the issue. Results In stage 1, we identified 60 usability issues that violated a total of 108 heuristics. In stage 2, 18 additional usability issues that violated 27 heuristics were identified by the study experts. Impact ratings ranged from all experts rating the issue as “no impact” to 5 out of 6 experts rating the issue as having a “large negative impact.” On average, the older adult care partner representative rated usability issues as being more significant more of the time. In stage 3, 31 usability issues were rated by an IT professional as “impossible to address,” 21 as “maybe,” and 24 as “can be addressed.” Conclusions Integrating diverse expertise when evaluating usability is important when patient safety is at stake. The non-HFE experts, included in stage 2 of our evaluation, identified 23% (18/78) of all the usability issues and, depending on their expertise, rated those issues as having differing impacts on patient comprehension and safety. Our findings suggest that, to conduct a comprehensive heuristic evaluation, expertise from all the contexts in which the AVS is used must be considered. Combining those findings with ratings from an IT expert, usability issues can be strategically addressed through redesign. Thus, a 3-staged heuristic evaluation method offers a framework for integrating context-specific expertise efficiently, while providing practical insights to guide human-centered design.

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Human-centered design of team health IT for pediatric trauma care transitions

Cited by 10 publications

References 35 publications

Decision‐making for pediatric cervical spine imaging after blunt trauma: Investigating team dynamics in the emergency department

Decision‐making for pediatric cervical spine imaging after blunt trauma: Investigating team dynamics in the emergency department

The Role of Human and Organizational Factors in the Pursuit of One Digital Health

Evaluating the Usability of an Emergency Department After Visit Summary: Staged Heuristic Evaluation

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