Aged and Extended Care Services, The Queen Elizabeth Hospital.
Adelaide Geriatrics Training and with Aged Care (GTRAC) Centre, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia.
Int J Evid Based Healthc. 2018 Jun;16(2):90-100. doi: 10.1097/XEB.0000000000000129.
To evaluate clinicians' perspectives, before and after clinical implementation (i.e. trial) of a handheld health information technology (HIT) tool, incorporating an iPad device and automatically generated visual cues for bedside display, for falls risk assessment and prevention in hospital.
This pilot study utilized mixed-methods research with focus group discussions and Likert-scale surveys to elicit clinicians' attitudes. The study was conducted across three phases within two medical wards of the Queen Elizabeth Hospital. Phase 1 (pretrial) involved focus group discussion (five staff) and surveys (48 staff) to elicit preliminary perspectives on tool use, benefits and barriers to use and recommendations for improvement. Phase 2 (tool trial) involved HIT tool implementation on two hospital wards over consecutive 12-week periods. Phase 3 (post-trial) involved focus group discussion (five staff) and surveys (29 staff) following tool implementation, with similar themes as in Phase 1. Qualitative data were evaluated using content analysis, and quantitative data using descriptive statistics and logistic regression analysis, with subgroup analyses on user status (P ≤ 0.05).
Four findings emerged on clinicians' experience, positive perceptions, negative perceptions and recommendations for improvement of the tool. Pretrial, clinicians were familiar with using visual cues in hospital falls prevention. They identified potential benefits of the HIT tool in obtaining timely, useful falls risk assessment to improve patient care. During the trial, the wards differed in methods of tool implementation, resulting in lower uptake by clinicians on the subacute ward. Post-trial, clinicians remained supportive for incorporating the tool into clinical practice; however, there were issues with usability and lack of time for tool use. Staff who had not used the tool had less appreciation for it improving their understanding of patients' falls risk factors (odds ratio 0.12), or effectively preventing hospital falls (odds ratio 0.12). Clinicians' recommendations resulted in subsequent technological refinement of the tool, and provision of an additional iPad device for more efficient use.
This study adds to the limited pool of knowledge about clinicians' attitudes toward health technology use in falls avoidance. Clinicians were willing to use the HIT tool, and their concerns about its usability were addressed in ongoing tool improvement. Including end-users in the development and refinement processes, as well as having high staff uptake of new technologies, is important in improving their acceptance and usage, and in maximizing beneficial feedback to further inform tool development.
评估临床医生在手持式医疗信息技术（HIT）工具临床实施（即试验）前后的观点，该工具整合了 iPad 设备和自动生成的床边视觉提示，用于医院跌倒风险评估和预防。
这项试点研究采用混合方法研究，利用焦点小组讨论和李克特量表调查来引出临床医生的态度。该研究在伊丽莎白女王医院的两个医疗病房进行了三个阶段。第 1 阶段（试验前）包括焦点小组讨论（5 名工作人员）和调查（48 名工作人员），以初步了解工具使用、使用的益处和障碍以及改进建议。第 2 阶段（工具试验）涉及在两个医院病房连续 12 周内实施 HIT 工具。第 3 阶段（试验后）在工具实施后进行焦点小组讨论（5 名工作人员）和调查（29 名工作人员），与第 1 阶段的主题类似。使用内容分析法评估定性数据，使用描述性统计和逻辑回归分析评估定量数据，并对用户状态进行亚组分析（P≤0.05）。
临床医生的经验、积极看法、消极看法以及对工具改进的建议方面出现了四个发现。在试验前，临床医生熟悉在医院跌倒预防中使用视觉提示。他们确定了 HIT 工具在获得及时、有用的跌倒风险评估以改善患者护理方面的潜在益处。在试验期间，病房在工具实施方法上存在差异，导致亚急性病房的临床医生采用率较低。在试验后，临床医生仍然支持将该工具纳入临床实践；然而，存在可用性问题和缺乏工具使用时间。未使用该工具的员工对其提高对患者跌倒风险因素的理解（优势比 0.12）或有效预防医院跌倒（优势比 0.12）的作用认识不足。临床医生的建议导致了工具的后续技术改进，并提供了额外的 iPad 设备以提高使用效率。
本研究增加了关于临床医生在避免跌倒方面使用健康技术态度的有限知识储备。临床医生愿意使用 HIT 工具，并且在持续的工具改进中解决了他们对其可用性的担忧。让终端用户参与开发和改进过程，并提高新技术的员工采用率，对于提高他们的接受度和使用率以及最大限度地获得有益的反馈来进一步指导工具开发非常重要。
