Division of General and Thoracic Surgery, Seattle Children's Hospital, PO Box 50010, Seattle, WA 98105, USA.
Pediatrics. 2012 Sep;130(3):e547-52. doi: 10.1542/peds.2011-3408. Epub 2012 Aug 13.
To evaluate whether systematically developed clinical decision supports provide usability benefit or decreased cognitive workload with their use.
Seven surgeons at a pediatric hospital at different levels of training (3 residents, 3 fellows, and 1 attending) were randomized to use either a historical control (ad hoc developed order set) or a systematically developed order set for postoperative management of appendicitis in children. After a washout period, they were crossed over to the other order set. Participants were videorecorded and completed postsurveys, including the System Usability Scale and the National Aeronautic and Space Administration-Task Load Index.
Participants unanimously preferred using systematically developed order sets. These order sets resulted in higher usability scores (75 ± 10 vs 60 ± 19; P < .05) and lower cognitive workload scores (37.7 ± 15 vs 52.2 ± 12; P < .05), with comparable amounts of time spent, mouse clicks, and free text entry. Orders generated were more likely to conform to established clinical guidelines.
Systematically designed order sets provide a reduction in cognitive workload and order variation in the context of improved system usability and improved guideline adherence. The systematically designed order set did not improve time spent, reduce mouse clicks, or reduce free text entry.
评估系统开发的临床决策支持是否在使用时具有可用性优势或降低认知工作量。
在一家儿童医院，7 名不同培训水平的外科医生（3 名住院医师、3 名研究员和 1 名主治医生）被随机分配使用历史对照组（临时开发的医嘱集）或系统开发的医嘱集来管理儿童阑尾炎的术后。在洗脱期后，他们交叉使用另一个医嘱集。参与者被录像并完成了问卷调查，包括系统可用性量表和美国国家航空航天局任务负荷指数。
参与者一致更喜欢使用系统开发的医嘱集。这些医嘱集的可用性评分更高（75±10 分比 60±19 分；P<0.05），认知工作量评分更低（37.7±15 分比 52.2±12 分；P<0.05），但花费的时间、鼠标点击次数和自由文本输入量相当。生成的医嘱更符合既定的临床指南。
系统设计的医嘱集在提高系统可用性和改善指南依从性的同时，降低了认知工作量和医嘱的变异性。系统设计的医嘱集并未减少花费的时间、鼠标点击次数或自由文本输入量。
