End user experience of a widely used artificial intelligence based sepsis system.

Objectives: Research on the Epic Sepsis System (ESS) has predominantly focused on technical accuracy, neglecting the user experience of healthcare professionals. Understanding these experiences is crucial for the design of Artificial Intelligence (AI) systems in clinical settings. This study aims to explore the socio-technical dynamics affecting ESS adoption and use, based on user perceptions and experiences.

Workflow analysis of breast cancer treatment decision-making: challenges and opportunities for informatics to support patient-centered cancer care.

Objective: Decision support can improve shared decision-making for breast cancer treatment, but workflow barriers have hindered widespread use of these tools. The goal of this study was to understand the workflow among breast cancer teams of clinicians, patients, and their family caregivers when making treatment decisions and identify design guidelines for informatics tools to better support treatment decision-making.

Materials And Methods: We conducted observations of breast cancer clinicians during routine clinical care from February to August 2022.

Retrospective analysis of the human-centered design process used to develop a clinical decision support in the emergency department: PE Dx Study Part 2.

With the growing implementation and use of health IT such as Clinical Decision Support (CDS), there is increasing attention on the potential negative impact of these technologies on patients (e.g., medication errors) and clinicians (e.

Post-implementation usability evaluation of a human factors-based clinical decision support for pulmonary embolism (PE) diagnosis (Dx): PE Dx Study Part 1.

While there is promise for health IT, such as Clinical Decision Support (CDS), to improve patient safety and clinician efficiency, poor usability has hindered widespread use of these tools. Human Factors (HF) principles and methods remain the gold standard for health IT design; however, there is limited information on how HF methods and principles influence CDS usability "in the wild". In this study, we explore the usability of an HF-based CDS used in the clinical environment; the CDS was designed according to a human-centered design process, which is described in Carayon et al.

Adapting Cognitive Task Analysis Methods for Use in a Large Sample Simulation Study of High-Risk Healthcare Events.

Cognitive task analysis (CTA) methods are traditionally used to conduct small-sample, in-depth studies. In this case study, CTA methods were adapted for a large multi-site study in which 102 anesthesiologists worked through four different high-fidelity simulated high-consequence incidents. Cognitive interviews were used to elicit decision processes following each simulated incident.

Decision-making in anesthesiology: will artificial intelligence make intraoperative care safer?

Purpose Of Review: This article explores the impact of recent applications of artificial intelligence on clinical anesthesiologists' decision-making.

Recent Findings: Naturalistic decision-making, a rich research field that aims to understand how cognitive work is accomplished in complex environments, provides insight into anesthesiologists' decision processes. Due to the complexity of clinical work and limits of human decision-making (e.

Decision-Making During High-Risk Events: A Systematic Literature Review.

Effective decision-making in crisis events is challenging due to time pressure, uncertainty, and dynamic decisional environments. We conducted a systematic literature review in PubMed and PsycINFO, identifying 32 empiric research papers that examine how trained professionals make naturalistic decisions under pressure. We used structured qualitative analysis methods to extract key themes.

The decision aid is the easy part: workflow challenges of shared decision making in cancer care.

Delivering high-quality, patient-centered cancer care remains a challenge. Both the National Academy of Medicine and the American Society of Clinical Oncology recommend shared decision making to improve patient-centered care, but widespread adoption of shared decision making into clinical care has been limited. Shared decision making is a process in which a patient and the patient's health-care professional weigh the risks and benefits of different options and come to a joint decision on the best course of action for that patient on the basis of their values, preferences, and goals for care.

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

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.

Satisfaction of Older Patients With Emergency Department Care: Psychometric Properties and Construct Validity of the Consumer Emergency Care Satisfaction Scale.

Background: Patient satisfaction is an important indicator of quality of care, but its measurement remains challenging. The Consumer Emergency Care Satisfaction Scale (CECSS) was developed to measure patient satisfaction in the emergency department (ED). Although this is a valid and reliable tool, several aspects of the CECSS need to be improved, including the definition, dimension, and scoring of scales.

A Sociotechnical Systems Framework for the Application of Artificial Intelligence in Health Care Delivery.

In the coming years, artificial intelligence (AI) will pervade almost every aspect of the health care delivery system. AI has the potential to improve patient safety (e.g.

Understanding Patient and Clinician Reported Nonroutine Events in Ambulatory Surgery.

Objective: Nonroutine events (NREs, i.e., deviations from optimal care) can identify care process deficiencies and safety risks.

Older Adult Patients and Care Partners as Knowledge Brokers in Fragmented Health Care.

Objective: To describe older adult patients' and care partners' knowledge broker roles during emergency department (ED) visits.

Background: Older adult patients are vulnerable to communication and coordination challenges during an ED visit, which can be exacerbated by the time and resource constrained ED environment. Yet, as a constant throughout the patient journey, patients and care partners can act as an information conduit, or knowledge broker, between fragmented care systems to attain high-quality, safe care.

Usability of a Human Factors-based Clinical Decision Support in the Emergency Department: Lessons Learned for Design and Implementation.

Objective: To evaluate the usability and use of human factors (HF)-based clinical decision support (CDS) implemented in the emergency department (ED).

Background: Clinical decision support can improve patient safety; however, the acceptance and use of CDS has faced challenges. Following a human-centered design process, we designed a CDS to support pulmonary embolism (PE) diagnosis in the ED.

Collaborative design and implementation of a clinical decision support system for automated fall-risk identification and referrals in emergency departments.

Of the 3 million older adults seeking fall-related emergency care each year, nearly one-third visited the Emergency Department (ED) in the previous 6 months. ED providers have a great opportunity to refer patients for fall prevention services at these initial visits, but lack feasible tools for identifying those at highest-risk. Existing fall screening tools have been poorly adopted due to ED staff/provider burden and lack of workflow integration.

Usability barriers and facilitators of a human factors engineering-based clinical decision support technology for diagnosing pulmonary embolism.

Background: Health IT, such as clinical decision support (CDS), has the potential to improve patient safety. However, poor usability of health IT continues to be a major concern. Human factors engineering (HFE) approaches are recommended to improve the usability of health IT.

Physician Perceptions of Disposition Decision-making for Older Adults in the Emergency Department: A Preliminary Analysis.

Disposition decision-making in the emergency department (ED) is critical to patient safety and quality of care. Disposition decision-making has particularly important implications for older adults who comprise a significant portion of ED visits annually and are vulnerable to suboptimal outcomes throughout ED care transitions. We conducted a secondary inductive content analysis of interviews with ED physicians (N= 11) to explore their perceptions of who they involve in disposition decision-making and what information they use to make disposition decisions for older adults.

Workflow integration analysis of a human factors-based clinical decision support in the emergency department.

Numerous challenges with the implementation, acceptance, and use of health IT are related to poor usability and a lack of integration of the technologies into clinical workflow, and have, therefore, limited the potential of these technologies to improve patient safety. We propose a definition and conceptual model of health IT workflow integration. Using interviews of 12 emergency department (ED) physicians, we identify 134 excerpts of barriers and facilitators to workflow integration of a human factors (HF)-based clinical decision support (CDS) implemented in the ED.

Moving toward a sociotechnical systems approach to continuous health information technology design: the path forward for improving electronic health record usability and reducing clinician burnout.

Based on our analysis of descriptions provided by four EHR vendors on their EHR usability efforts, we provide three recommendations aimed at improving the usability of health information technology and reducing clinician burnout. First, EHR vendors need to dedicate increased attention to the design of the entire sociotechnical (work) system, including the EHR technology and its usability as well as the interactions of the technology with other system elements. Second, EHR vendors need to deepen and broaden their understanding of the work of clinicians and care teams by using diverse and mixed method.

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

Objective: In 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 Methods: We 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.

The Design of PE Dx, a CDS to Support Pulmonary Embolism Diagnosis in the ED.

Designing and implementing clinical decision support (CDS) in health care has been challenging. Attempts have been made to design and implement CDS to support clinical procedures, but many of these CDSs have met user resistance. One possible explanation for the lack of acceptability can be the poor design of the CDS.

Role network measures to assess healthcare team adaptation to complex situations: the case of venous thromboembolism prophylaxis.

Hospitals are complex environments that rely on clinicians working together to provide appropriate care to patients. These clinical teams adapt their interactions to meet changing situational needs. Venous thromboembolism (VTE) prophylaxis is a complex process that occurs throughout a patient's hospitalisation, presenting five stages with different levels of complexity: admission, interruption, re-initiation, initiation, and transfer.

Challenges And Opportunities For Improving Patient Safety Through Human Factors And Systems Engineering.

Despite progress on patient safety since the publication of the Institute of Medicine's 1999 report, To Err Is Human, significant problems remain. Human factors and systems engineering (HF/SE) has been increasingly recognized and advocated for its value in understanding, improving, and redesigning processes for safer care, especially for complex interacting sociotechnical systems. However, broad awareness of HF/SE and its adoption into safety improvement work have been frustratingly slow.