HumanEra, Office of Research and Innovation, North York General Hospital, 4001 Leslie Street, LE-140, North York, ON, Canada.
HumanEra, Office of Research and Innovation, North York General Hospital, 4001 Leslie Street, LE-140, North York, ON, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto; 164 College St, Toronto, ON, Canada.
Int J Med Inform. 2020 Jan;133:103969. doi: 10.1016/j.ijmedinf.2019.103969. Epub 2019 Sep 14.
The Bedside Paediatric Early Warning System (BedsidePEWS) is a clinical decision support tool designed to augment clinician expertise, objectively identify children at risk for clinical deterioration, and standardize and prioritize care to improve outcomes in community settings. Although the paper-based BedsidePEWS documentation record has been shown to improve clinicians' perception of their ability to detect deterioration and follow care recommendations, research is needed to asses this impact empirically. Furthermore, as hospitals progressively move toward electronic clinical systems, knowledge regarding the impact of BedsidePEWS' novel electronic interface on clinicians' performance and user experience is required.
The primary objectives of this study were (1) to compare adherence to evidence-based care recommendations using a) electronic health record software, b) paper BedsidePEWS, and c) a novel electronic BedsidePEWS interface, and (2) to describe end-users' experiences of usability and opportunities for improvement of both paper and electronic BedsidePEWS.
Paediatric nurses participated in a repeated measures simulation study. Participants assessed simulated patients, documented patient data, and responded to a series of questions regarding follow-up care for each patient. Three patient types (i.e., stable, mild deterioration, severe deterioration) were assessed in each of three intervention conditions (i.e., electronic health record, paper BedsidePEWS, electronic BedsidePEWS). Following simulation scenarios, participants provided comments regarding the usability of the paper and electronic tools.
Participants made 12.7% and 18.0% more appropriate care decisions with paper and electronic BedsidePEWS, respectively, than with the electronic health record intervention (p < 0.001). Accurate BedsidePEWS severity of illness score calculation was related to better adherence to evidence-based care recommendations (65%), compared to inaccurate calculation (55%), and electronic BedsidePEWS was associated with 15.7% fewer calculation errors than paper (p < 0.005). Electronic BedsidePEWS demonstrated usability benefits over its paper predecessor, including automatic score calculation and data plotting, and the potential to eliminate double charting, and participants expressed a preference for electronic BedsidePEWS in all aspects of the debrief questionnaire (p < 0.001).
BedsidePEWS in both paper and electronic formats significantly improved participants' ability to detect deterioration and follow care recommendations compared to electronic health record software. Furthermore, results suggest that electronic BedsidePEWS would afford improved patient care in excess of the paper-based original and further contribute to the standardization, prioritization, and improvement of care in community settings.
床边儿科早期预警系统（BedsidePEWS）是一种临床决策支持工具，旨在增强临床医生的专业知识，客观识别有临床恶化风险的儿童，并标准化和优先考虑护理，以改善社区环境中的治疗结果。尽管纸质版的床边 PEWS 文档记录已被证明可以提高临床医生对其识别恶化能力和遵循护理建议的能力，但需要进行研究以从经验上评估这种影响。此外，随着医院逐渐向电子临床系统转移，需要了解床边 PEWS 的新型电子界面对临床医生的表现和用户体验的影响。
本研究的主要目的是（1）比较使用 a）电子健康记录软件、b）纸质床边 PEWS 和 c）新型电子床边 PEWS 界面来评估对基于证据的护理建议的依从性，以及（2）描述实际使用者对纸质和电子床边 PEWS 的可用性和改进机会的体验。
儿科护士参与了一项重复测量模拟研究。参与者评估模拟患者、记录患者数据，并对每位患者的后续护理问题进行了一系列回答。在三种干预条件下（即电子健康记录、纸质床边 PEWS、电子床边 PEWS）评估了三种患者类型（即稳定、轻度恶化、重度恶化）。模拟场景结束后，参与者就纸质和电子工具的可用性提供了意见。
与电子健康记录干预相比，参与者使用纸质和电子床边 PEWS 做出了分别为 12.7%和 18.0%的更恰当的护理决策（p<0.001）。准确计算床边 PEWS 疾病严重程度评分与更好地遵循基于证据的护理建议相关（65%），相比之下不准确计算（55%），电子床边 PEWS 与纸质相比，计算错误减少了 15.7%（p<0.005）。电子床边 PEWS 相对于其纸质前身具有可用性优势，包括自动评分计算和数据绘图，并且有可能消除双重图表，参与者在所有方面的反馈问卷中都表示对电子床边 PEWS 的偏好（p<0.001）。
纸质和电子格式的床边 PEWS 均显著提高了参与者识别恶化和遵循护理建议的能力，与电子健康记录软件相比。此外，结果表明，电子床边 PEWS 将在社区环境中提供改善的患者护理，超过基于纸张的原始版本，并进一步有助于标准化、优先化和改善护理。
