Gephart Sheila M, Tolentino D Anthony, Quinn Megan C, Wyles Christina
Author Affiliations: College of Nursing, The University of Arizona (Dr Gephart and Mrs Wyles), Tucson; National Clinician Scholars Program, School of Nursing and Institute for Healthcare Policy and Innovation, University of Michigan (Dr Tolentino), Ann Arbor; and School of Nursing, Oregon Health Sciences University (Dr Quinn), Portland.
Comput Inform Nurs. 2023 Feb 1;41(2):94-101. doi: 10.1097/CIN.0000000000000929.
Decision support in neonatal ICUs is needed, especially for prevention and risk awareness of the devastating complication of necrotizing enterocolitis, a major cause of emergency surgery among fragile infants. The purpose of this study was to describe the current clinical workflow and sociotechnical processes among clinicians for necrotizing enterocolitis risk awareness, timely recognition of symptoms, and treatment to inform decision support design. A qualitative descriptive study was conducted. Focus groups were held in two neonatal ICUs (five groups in Unit A and six in Unit B). Transcripts were analyzed using content analysis and compared with field notes. Clinicians (N = 27) included nurses (37%), physicians (30%), neonatal nurse practitioners (19%), and other staff (16%). Workflow processes differed for nurses (who see necrotizing enterocolitis signs and notify providers to order diagnostic tests and treatments) and providers (who receive notification of necrotizing enterocolitis concern and then decide how to act). Clinicians desired (1) a necrotizing enterocolitis-relevant dashboard to support nutrition tracking and necrotizing enterocolitis recognition; (2) features to support decision-making (eg, necrotizing enterocolitis risk and adherence scoring); (3) breast milk tracking and feeding clinical decision support; (4) tools for necrotizing enterocolitis surveillance and quality reporting; and (5) general EHR optimizations to improve user experience.
新生儿重症监护病房需要决策支持，尤其是在预防坏死性小肠结肠炎这一毁灭性并发症及其风险意识方面，坏死性小肠结肠炎是脆弱婴儿进行急诊手术的主要原因。本研究的目的是描述临床医生目前针对坏死性小肠结肠炎风险意识、症状的及时识别和治疗的临床工作流程及社会技术过程，以为决策支持设计提供信息。开展了一项定性描述性研究。在两个新生儿重症监护病房进行了焦点小组讨论（A单元5组，B单元6组）。使用内容分析法对访谈记录进行分析，并与现场记录进行比较。临床医生（N = 27）包括护士（37%）、医生（30%）、新生儿执业护士（19%）和其他工作人员（16%）。护士（负责查看坏死性小肠结肠炎体征并通知医护人员安排诊断检查和治疗）和医护人员（负责接收坏死性小肠结肠炎相关问题的通知，然后决定如何行动）的工作流程有所不同。临床医生希望：（1）有一个与坏死性小肠结肠炎相关的仪表板，以支持营养追踪和坏死性小肠结肠炎识别；（2）具备支持决策的功能（如坏死性小肠结肠炎风险和依从性评分）；（3）母乳追踪和喂养临床决策支持；（4）用于坏死性小肠结肠炎监测和质量报告的工具；以及（5）对电子健康记录进行总体优化以改善用户体验。
