开发、试点测试和完善 3 项电子病历集成干预措施的要求,以改善急症护理中的诊断安全:以用户为中心的方法。

IF 2.5 Q2 HEALTH CARE SCIENCES & SERVICES
JAMIA Open Pub Date : 2023-05-10 eCollection Date: 2023-07-01 DOI:10.1093/jamiaopen/ooad031
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引用次数: 0

摘要

摘要描述一种以用户为中心的方法,以开发、试点测试和完善针对住院患者关键诊断流程故障的 3 种电子健康记录(EHR)集成干预措施的要求:优先开发了三项干预措施:电子病历集成仪表板中的诊断安全栏 (DSC),用于识别高危患者;诊断超时 (DTO),用于临床医生重新评估工作诊断;以及患者诊断问卷 (PDQ),用于收集患者对诊断过程的担忧。通过分析 DSC 逻辑预测风险升高的测试病例与临床医生工作组感知风险的比较、与临床医生进行的 DTO 测试会议、患者的 PDQ 回复以及与临床医生和患者顾问进行的焦点小组讨论,并使用故事板对综合干预措施进行建模,完善了最初的要求。采用混合方法对参与者的回复进行分析,以确定最终要求和潜在的实施障碍:结果:通过对 DSC 预测的 10 个测试案例、18 名临床医生 DTO 参与者和 39 份 PDQ 回复的分析,最终需求包括以下内容:DSC 可配置参数(变量、权重),以便根据住院期间收集到的新临床数据实时调整基线风险估计值;DTO 措辞更简洁,临床医生可在患者在场或不在场的情况下灵活进行 DTO;将 PDQ 回复整合到 DSC 中,以确保与临床医生进行闭环交流。对焦点小组的分析证实,有必要将干预措施与电子病历紧密结合,以促使临床医生在诊断错误(DE)风险或不确定性较高的病例中重新考虑工作诊断。潜在的实施障碍包括警报疲劳和对风险算法的不信任(DSC);时间限制、冗余和对向患者披露不确定性的担忧(DTO);以及患者不同意护理团队的诊断(PDQ):讨论:以用户为中心的方法导致了 3 项干预措施要求的演变,这些干预措施针对的是有 DE 风险的住院患者在诊断过程中的关键失误:我们从以用户为中心的设计过程中发现了挑战并提供了经验。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Developing, pilot testing, and refining requirements for 3 EHR-integrated interventions to improve diagnostic safety in acute care: a user-centered approach.

Developing, pilot testing, and refining requirements for 3 EHR-integrated interventions to improve diagnostic safety in acute care: a user-centered approach.

Developing, pilot testing, and refining requirements for 3 EHR-integrated interventions to improve diagnostic safety in acute care: a user-centered approach.

Developing, pilot testing, and refining requirements for 3 EHR-integrated interventions to improve diagnostic safety in acute care: a user-centered approach.

Objective: To describe a user-centered approach to develop, pilot test, and refine requirements for 3 electronic health record (EHR)-integrated interventions that target key diagnostic process failures in hospitalized patients.

Materials and methods: Three interventions were prioritized for development: a Diagnostic Safety Column (DSC) within an EHR-integrated dashboard to identify at-risk patients; a Diagnostic Time-Out (DTO) for clinicians to reassess the working diagnosis; and a Patient Diagnosis Questionnaire (PDQ) to gather patient concerns about the diagnostic process. Initial requirements were refined from analysis of test cases with elevated risk predicted by DSC logic compared to risk perceived by a clinician working group; DTO testing sessions with clinicians; PDQ responses from patients; and focus groups with clinicians and patient advisors using storyboarding to model the integrated interventions. Mixed methods analysis of participant responses was used to identify final requirements and potential implementation barriers.

Results: Final requirements from analysis of 10 test cases predicted by the DSC, 18 clinician DTO participants, and 39 PDQ responses included the following: DSC configurable parameters (variables, weights) to adjust baseline risk estimates in real-time based on new clinical data collected during hospitalization; more concise DTO wording and flexibility for clinicians to conduct the DTO with or without the patient present; and integration of PDQ responses into the DSC to ensure closed-looped communication with clinicians. Analysis of focus groups confirmed that tight integration of the interventions with the EHR would be necessary to prompt clinicians to reconsider the working diagnosis in cases with elevated diagnostic error (DE) risk or uncertainty. Potential implementation barriers included alert fatigue and distrust of the risk algorithm (DSC); time constraints, redundancies, and concerns about disclosing uncertainty to patients (DTO); and patient disagreement with the care team's diagnosis (PDQ).

Discussion: A user-centered approach led to evolution of requirements for 3 interventions targeting key diagnostic process failures in hospitalized patients at risk for DE.

Conclusions: We identify challenges and offer lessons from our user-centered design process.

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来源期刊
JAMIA Open
JAMIA Open Medicine-Health Informatics
CiteScore
4.10
自引率
4.80%
发文量
102
审稿时长
16 weeks
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