Assessing workflow of emergency physicians in the use of clinical decision support

2019 ◽  
Vol 63 (1) ◽  
pp. 772-776 ◽  
Author(s):  
Megan E. Salwei ◽  
Pascale Carayon ◽  
Peter Hoonakker ◽  
Ann Schoofs Hundt ◽  
Clair Novak ◽  
...  
Keyword(s):  
Clinical Decision ◽  
Emergency Physicians ◽  
Web Based ◽  
Potential Barriers ◽  
Workflow Integration ◽  
Patient Scenario ◽  
Life Threatening ◽  
Risk Scoring ◽  
Clinical Decision Supports ◽  
Specific Symptoms

The emergency department (ED) is a complex environment where diagnoses must often be made quickly, based on incomplete information. Pulmonary embolism (PE) is an especially challenging diagnosis that is frequently delayed or missed due to its non-specific symptoms, and can be life-threatening when not treated. Clinical decision supports (CDS) have the potential to improve these difficult decisions; however, previous efforts to implement CDS in the ED have faced challenges due to poor usability and lack of workflow integration. The objective of this study is to identify potential barriers to workflow integration from the technology’s implementation and inform the CDS design; this is achieved by analyzing ED physicians’ workflow during a usability evaluation of two different CDS, a web-based risk scoring CDS and a CDS designed using an human-centered design (HCD) process and human factors (HF) design principles. The number of cases matching the guideline-based workflow and the percent of correct diagnostic decisions increased from the use of the HF-based CDS, but varied depending on the patient scenario. We identified three workflow variations, which had both positive and negative implications for the CDS design and implementation. The workflow analysis can be used to inform the CDS design and improve the technology’s usability and integration in physician workflow prior to implementation.

scholarly journals Application of human factors to improve usability of clinical decision support for diagnostic decision-making: a scenario-based simulation study

2019 ◽  
Vol 29 (4) ◽  
pp. 329-340
Author(s):  
Pascale Carayon ◽  
Peter Hoonakker ◽  
Ann Schoofs Hundt ◽  
Megan Salwei ◽  
Douglas Wiegmann ◽  
...  
Keyword(s):  
Decision Making ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Simulation Study ◽  
Information Acquisition ◽  
Clinical Decision ◽  
Emergency Physicians ◽  
Web Based ◽  
Diagnostic Decision ◽  
Diagnostic Decision Making

ObjectiveIn this study, we used human factors (HF) methods and principles to design a clinical decision support (CDS) that provides cognitive support to the pulmonary embolism (PE) diagnostic decision-making process in the emergency department. We hypothesised that the application of HF methods and principles will produce a more usable CDS that improves PE diagnostic decision-making, in particular decision about appropriate clinical pathway.Materials and methodsWe conducted a scenario-based simulation study to compare a HF-based CDS (the so-called CDS for PE diagnosis (PE-Dx CDS)) with a web-based CDS (MDCalc); 32 emergency physicians performed various tasks using both CDS. PE-Dx integrated HF design principles such as automating information acquisition and analysis, and minimising workload. We assessed all three dimensions of usability using both objective and subjective measures: effectiveness (eg, appropriate decision regarding the PE diagnostic pathway), efficiency (eg, time spent, perceived workload) and satisfaction (perceived usability of CDS).ResultsEmergency physicians made more appropriate diagnostic decisions (94% with PE-Dx; 84% with web-based CDS; p<0.01) and performed experimental tasks faster with the PE-Dx CDS (on average 96 s per scenario with PE-Dx; 117 s with web-based CDS; p<0.001). They also reported lower workload (p<0.001) and higher satisfaction (p<0.001) with PE-Dx.ConclusionsThis simulation study shows that HF methods and principles can improve usability of CDS and diagnostic decision-making. Aspects of the HF-based CDS that provided cognitive support to emergency physicians and improved diagnostic performance included automation of information acquisition (eg, auto-populating risk scoring algorithms), minimisation of workload and support of decision selection (eg, recommending a clinical pathway). These HF design principles can be applied to the design of other CDS technologies to improve diagnostic safety.

Successful Control of Massive Vaginal Bleeding with Resuscitative Endovascular Balloon Occlusion of the Aorta and Pelvic Packing

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Emre Özlüer ◽  
Çagaç Yetis ◽  
Evrim Sayin ◽  
Mücahit Avcil
Keyword(s):  
Vaginal Bleeding ◽  
Balloon Occlusion ◽  
Emergency Physicians ◽  
Pelvic Packing ◽  
Gynecological Malignancies ◽  
Life Threatening ◽  
Successful Control ◽  
Endovascular Balloon Occlusion

Gynecological malignancies may present as life-threatening vaginal bleeding. Pelvic packing and Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) may be useful along with conventional vaginal packing when in terms of control of the hemorrhage. Emergency physicians should be able to perform these interventions promptly in order to save their patients from exsanguination.

scholarly journals Challenges involved in establishing a web-based clinical decision support tool in community health centers

Healthcare ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 100488
Author(s):  
Rachel Gold ◽  
Mary Middendorf ◽  
John Heintzman ◽  
Joan Nelson ◽  
Patrick O'Connor ◽  
...  
Keyword(s):  
Decision Support ◽  
Community Health ◽  
Clinical Decision Support ◽  
Community Health Centers ◽  
Decision Support Tool ◽  
Clinical Decision ◽  
Health Centers ◽  
Web Based ◽  
Support Tool ◽  
Clinical Decision Support Tool

scholarly journals Developing a scoring tool to estimate the risk of deterioration for normotensive patients with acute pulmonary embolism on admission

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yizhuo Gao ◽  
Chao Ji ◽  
Hongyu Zhao ◽  
Jun Han ◽  
Haitao Shen ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Clinical Laboratory ◽  
Systolic Pressure ◽  
Adverse Outcomes ◽  
Web Based ◽  
Derivation Cohort ◽  
Risk Scoring ◽  
Scoring Tool ◽  
Acute Pe

Abstract Background It is important to identify deterioration in normotensive patients with acute pulmonary embolism (PE). This study aimed to develop a tool for predicting deterioration among normotensive patients with acute PE on admission. Methods Clinical, laboratory, and computed tomography parameters were retrospectively collected for normotensive patients with acute PE who were treated at a Chinese center from January 2011 to May 2020 on admission into the hospital. The endpoint of the deterioration was any adverse outcome within 30 days. Eligible patients were randomized 2:1 to derivation and validation cohorts, and a nomogram was developed and validated by the aforementioned cohorts, respectively. The areas under the curves (AUCs) with 95% confidence intervals (CIs) were calculated. A risk-scoring tool for predicting deterioration was applied as a web-based calculator. Results The 845 eligible patients (420 men, 425 women) had an average age of 60.05 ± 15.43 years. Adverse outcomes were identified for 81 patients (9.6%). The nomogram for adverse outcomes included heart rate, systolic pressure, N-terminal-pro brain natriuretic peptide, and ventricle/atrial diameter ratios at 4-chamber view, which provided AUC values of 0.925 in the derivation cohort (95% CI 0.900–0.946, p < 0.001) and 0.900 in the validation cohort (95% CI 0.883–0.948, p < 0.001). A risk-scoring tool was published as a web-based calculator (https://gaoyzcmu.shinyapps.io/APE9AD/). Conclusions We developed a web-based scoring tool that may help predict deterioration in normotensive patients with acute PE.

scholarly journals Evaluation of the effect of the COVID-19 pandemic on clinical characteristics and psychological status in internet consultation respondents

2021 ◽  
Vol 104 (2) ◽  
pp. 003685042110146
Author(s):  
Han Ouyang ◽  
Jian Wen ◽  
Wenyong Gu ◽  
Huaying Shen ◽  
Kai Song
Keyword(s):  
Clinical Characteristics ◽  
Psychological Status ◽  
High Risk Population ◽  
Positive Role ◽  
Younger Women ◽  
Related Information ◽  
Life Threatening ◽  
Education Groups ◽  
Specific Symptoms ◽  
Severe Anxiety

COVID-19 is a sudden, infectious disease that can be life-threatening and may cause people to feel panic and anxiety. This study aimed to investigate the clinical characteristics and psychological status of a specific population using an internet consultation platform during the outbreak of COVID-19. The questionnaire survey included questions regarding basic information (e.g. area, sex, age, occupation, and education level), clinical characteristics, and cognitive and psychological status concerning COVID-19 from January 31, 2020 to March 31, 2020. There were 277 patients (43.49%) with three or more symptoms, 121 (12.11%) with a clinical questionnaire score ≥8, and 6.81% who lived in Hubei in the previous 14 days. Of the respondents, 4.9% had contact fever or were confirmed to have COVID-19 in the previous 14 days. The respondents were mostly aware that COVID-19 can be transmitted from person to person and via the respiratory tract, but awareness of general susceptibility and specific symptoms of COVID-19 was low. Multivariate analysis showed that urban residents, clerk/students and higher education groups were well aware of COVID-19. Regarding mental health, the anxiety score of the respondents was 7.12 ± 2.32, and the proportion of anxiety was 54.15%. Younger women were more likely to have anxiety when they experienced positive symptoms. Individuals with a Hubei residence history and those who had contact with an individual with a fever or were confirmed patients in the previous 14 days were more likely to have moderate or severe anxiety. The COVID-19-related knowledge of the respondents was generally good but still could have been improved. Their psychological status was also affected by the pandemic. The internet consultation platform played a positive role in spreading pandemic-related information, providing medical help and psychological counseling, and strengthening early warning to the potential high-risk population.

scholarly journals Diagnosing gastric volvulus in chest X-ray: report of three cases

2020 ◽  
Vol 2020 (7) ◽  
Author(s):  
Narendra Pandit ◽  
Abhijeet Kumar ◽  
Tek Narayan Yadav ◽  
Qamar Alam Irfan ◽  
Sujan Gautam ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Abdomen ◽  
Gastric Volvulus ◽  
X Ray ◽  
Pain Abdomen ◽  
Life Threatening ◽  
Chest X Ray ◽  
High Index Of Suspicion ◽  
Specific Symptoms ◽  
Prompt Diagnosis

Abstract Gastric volvulus is a rare abnormal rotation of the stomach along its axis. It is a surgical emergency, hence requires prompt diagnosis and treatment to prevent life-threatening gangrenous changes. Hence, a high index of suspicion is required in any patients presenting with an acute abdomen in emergency. The entity can present acutely with pain abdomen and vomiting, or as chronic with non-specific symptoms. Chest X-ray findings to diagnose it may be overlooked in patients with acute abdomen. Here, we report three patients with gastric volvulus, where the diagnosis was based on the chest X-ray findings, confirmed with computed tomography, and managed successfully with surgery.

scholarly journals Emergency physicians’ attitudes and perceived barriers to the implementation of take-home naloxone programs in Canadian emergency departments

CJEM ◽  
2017 ◽  
Vol 20 (1) ◽  
pp. 46-52 ◽  
Author(s):  
Lauren Lacroix ◽  
Lisa Thurgur ◽  
Aaron M. Orkin ◽  
Jeffrey J. Perry ◽  
Ian G. Stiell
Keyword(s):  
At Risk ◽  
Perceived Barriers ◽  
Face Validity ◽  
Opioid Overdose ◽  
Emergency Physicians ◽  
Web Based ◽  
Health Crisis ◽  
Canadian Association ◽  
National Public Health

AbstractObjectivesRates of opioid-related deaths have reached the level of national public health crisis in Canada. Community-based opioid overdose education and naloxone distribution (OEND) programs distribute naloxone to people at risk, and the emergency department (ED) may be an underutilized setting to deliver naloxone to these people. The goal of this study was to identify Canadian emergency physicians’ attitudes and perceived barriers to the implementation of take-home naloxone programs.MethodsThis was an anonymous Web-based survey of members of the Canadian Association of Emergency Physicians. Survey questions were developed by the research team and piloted for face validity and clarity. Two reminder emails were sent to non-responders at 2-week intervals. Respondent demographics were collected, and Likert scales were used to assess attitudes and barriers to the prescription of naloxone from the ED.ResultsA total of 459 physicians responded. The majority of respondents were male (64%), worked in urban tertiary centres (58.3%), and lived in Ontario (50.6%). Overall, attitudes to OEND were strongly positive; 86% identified a willingness to prescribe naloxone from the ED. Perceived barriers included support for patient education (57%), access to follow-up (44%), and inadequate time (37%). In addition to people at risk of overdose, 77% of respondents identified that friends and family members may also benefit.ConclusionsCanadian emergency physicians are willing to distribute take-home naloxone, but thoughtful systems are required to facilitate opioid OEND implementation. These data will inform the development of these programs, with emphasis on multidisciplinary training and education.

Increasing pediatric to adult healthcare transition services through clinical decision supports

2021 ◽  
Vol 61 ◽  
pp. 292-297
Author(s):  
Katherine Wu ◽  
Caren Steinway ◽  
Adam Greenberg ◽  
Zia Gajary ◽  
David Rubin ◽  
...  
Keyword(s):  
Clinical Decision ◽  
Transition Services ◽  
Healthcare Transition ◽  
Clinical Decision Supports

scholarly journals A Novel Narrative E-Writing Intervention for Parents of Children With Chronic Life-Threatening Illnesses: Protocol for a Pilot, Open-Label Randomized Controlled Trial (Preprint)

2020 ◽  
Author(s):  
Andy Hau Yan Ho ◽  
Oindrila Dutta ◽  
Geraldine Tan-Ho ◽  
Toh Hsiang Benny Tan ◽  
Casuarine Xinyi Low ◽  
...  
Keyword(s):  
Palliative Care ◽  
Controlled Trial ◽  
Well Being ◽  
Mobile App ◽  
Pediatric Palliative Care ◽  
Writing Intervention ◽  
Open Label ◽  
Web Based ◽  
Randomized Controlled ◽  
Life Threatening

BACKGROUND A novel evidence-based Narrative e-Writing Intervention (NeW-I) has been developed and tested in Singapore to advance psychosociospiritual support for parents of children with chronic life-threatening illnesses. NeW-I is informed by an international systematic review and a Singapore-based qualitative inquiry on the lived experience of parental bereavement and supported by literature on anticipatory grief interventions for improving the holistic well-being of parent caregivers of seriously ill children. OBJECTIVE This study's aim was to provide an accessible platform, NeW-I—which is a strengths- and meaning-focused and therapist-facilitated mobile app and web-based counseling platform—that aims to enhance quality of life, spiritual well-being, hope, and perceived social support and reduce depressive symptoms, caregiver burden, and risk of complicated grief among parents of children with chronic life-threatening illnesses. METHODS The NeW-I therapist-facilitated web-based platform comprises a mobile app and a website (both of which have the same content and functionality). NeW-I has been implemented in Singapore as a pilot open-label randomized controlled trial comprising intervention and control groups. Both primary and secondary outcomes will be self-reported by participants through questionnaires. In collaboration with leading pediatric palliative care providers in Singapore, the trial aims to enroll 36 participants in each group (N=72), so that when allowing for 30% attrition at follow-up, the sample size will be adequate to detect a small effect size of 0.2 in the primary outcome measure, with 90% power and two-sided significance level of at least .05. The potential effectiveness of NeW-I and the accessibility and feasibility of implementing and delivering the intervention will be assessed. RESULTS Funding support and institutional review board approval for this study have been secured. Data collection started in January 2019 and is ongoing. CONCLUSIONS NeW-I aspires to enhance holistic pediatric palliative care services through a structured web-based counseling platform that is sensitive to the unique cultural needs of Asian family caregivers who are uncomfortable with expressing emotion even during times of loss and separation. The findings of this pilot study will inform the development of a full-scale NeW-I protocol and further research to evaluate the efficacy of NeW-I in Singapore and in other Asian communities around the world. CLINICALTRIAL ClinicalTrials.gov NCT03684382; https://clinicaltrials.gov/ct2/show/NCT03684382 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/17561

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