The Value Institute at Christiana Care Health System is developing and evaluating a framework to optimize alert design for clinical decision support (CDS) to target sepsis, the most impactful disease process to our system. Our multifaceted approach takes into account technological, organizational, and provider factors that influence how providers interact with alerts throughout the hospitalization process when appropriate clinical care can change the trajectory of a patient with a systemic infection. Effective presentation of the alert, including how and what is displayed, may help providers extract information quickly, offering better cognitive support during busy patient encounters. Our simulated usability evaluation, using real clinical scenarios, investigates how clinicians detect sepsis and respond to CDS based on the way the information is presented visually. Usability testing is designed to better understand the decision-making process analyzing varied designs that utilize various levels of visual presentations to promote situational awareness and measure diagnosis- and treatment- related variables.
Get full access to this article
View all access options for this article.
References
1.
AhrensTTuggleD.Surviving severe sepsis: Early recognition and treatment. Crit Care Nurse. Oct2004;Suppl:2-13.
2.
AndrewsRElixhauserA.The national hospital bill: growth trends and 2005 update on the most expensive conditions by payer. Healthcare Cost and Utilization Project 2007.
3.
BatesDWTeichJMLeeJ. The impact of computerized physician order entry on medication error prevention. J Am Med Inform Assoc. 1999Jul;6(4):313–21.
4.
ChangRWJacobsSLeeB.Predicting outcome among intensive care unit patients using computerised trend analysis of daily Apache II scores corrected for organ system failure. Intens Care Med. 1988;14(5):558-66.
5.
ChassinMRLoebJMSchmaltzSPWachterRM. Accountability measures: using measurement to promote quality improvement. N Engl J Med. 2010; 363(7):683-688.
6.
DellingerRPLevyMMCarletJM. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. In: Crit Care Med36:296-327.
7.
ElixhauserAFriedmanBStrangesE. Septicemia in U.S. hospitals, 2009. Statistical Brief #122. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. Rockville (MD): Agency for Health Care Policy and Research (US); 2006-. 2011.
8.
GaieskiDFEdwardsJMKallanMJ. Benchmarking the incidence and mortality of severe sepsis in the United States. Crit Care Med. 2013;41(5):1167-74.
9.
HallMJWilliamsSNDeFrancesCJ. Inpatient care for septicemia or sepsis: a challenge for patients and hospitals. NCHS Data Brief. 2011;(62):1-8.
10.
HillmanKMBristowPJCheyT. Duration of life-threatening antecedents prior to intensive care admission. Intens Care Med. 2002; 28:1629-1634.
11.
HowellMDTalmorDSchuetzP. Proof of principle: the predisposition, infection, response, organ failure sepsis staging system. Crit Care Med. 2011;39(2):322-327.
12.
IsaacTWeissmanJSDavisRBMassagliMCyrulikASandsDZWeingartSN.Overrides of medication alerts in ambulatory care. Arch Intern Med. 2009;169(3):305-311.
13.
IwashynaTJOddenARohdeJ. Identifying patients with severe sepsis using administrative claims: patient-level validation of the Angus implementation of the international consensus conference definition of severe sepsis. Med Care. 2014;52(6):e39-e43.
14.
Joint Commission on Accreditation of Healthcare Organizations Jun 29, 2004. Sentinel event statistic.
15.
KaukonenKBaileyMSuzukiS. Mortality Related to Severe Sepsis and Septic Shock Among Critically Ill Patients in Australia and New Zealand, 2000-2012. JAMA. 2014;311(13):1308-1316. doi:10.1001/jama.2014.2637.
16.
KawamotoKHoulihanCABalasEA. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ. 2005 Apr 2;330(7494):765.
17.
KumarARobertsDWoodKE. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006;34:1589-96.
18.
LevyMMDellingerRPTownsendSR. Surviving Sepsis Campaign. Surviving Sepsis Campaign. The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis. Crit Care Med. 2010;38(2):367-374.
19.
LiuVEscobarGJGreeneJD. Hospital deaths in patients with sepsis from 2 independent cohorts. JAMA. 2014;312(1):90-92.
20.
MarshallJC. SIRS and MODS: what is their relevance to the science and practice of intensive care? Shock. 2000;14(6):586-589
21.
MillerKECapanMWuPJacksonEVArnoldRC. Operationalizing Alert Design for Clinical Decision Support. Proceedings of the International Symposium of Human Factors and Ergonomics in Healthcare. Forthcoming.
22.
MoormanBGeeT. Functional basic of third-party alarm notification systems. Horizons. Spring 2011;76-82.
23.
National Quality Forum.Infectious Disease Endorsement Maintenance: 0500 Severe Sepsis and Septic Shock Management Bundle. November28, 2012.
24.
RussALZillichAJMcManusMSDoebbelingBNSaleemJJ.Prescribers’ interactions with medication alerts at the point of prescribing: A multi-method, in situ investigation of the human-computer interaction. Int J Med Inform. 2012;81(4):232-43.
25.
TimsitJFFosseJPTrochéGDe LassenceAAlbertiCGarrouste-OrgeasMAzoulayEChevretSMoinePCohenY. Accuracy of a composite score using daily SAPS II and LOD scores for predicting hospital mortality in ICU patients hospitalized for more than 72 h. Intens Care Med. 2001;27(6):1012-21.
26.
VincentJL.Dear SIRS, I’m sorry to say that I don’t like you... Crit Care Med. 1997;25(2):372-374.
