Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
Harvard Medical School, Boston, Massachusetts, USA.
J Am Med Inform Assoc. 2022 Jul 12;29(8):1416-1424. doi: 10.1093/jamia/ocac035.
We developed a comprehensive, medication-related clinical decision support (CDS) software prototype for use in the operating room. The purpose of this study was to compare the usability of the CDS software to the current standard electronic health record (EHR) medication administration and documentation workflow.
The primary outcome was the time taken to complete all simulation tasks. Secondary outcomes were the total number of mouse clicks and the total distance traveled on the screen in pixels. Forty participants were randomized and assigned to complete 7 simulation tasks in 1 of 2 groups: (1) the CDS group (n = 20), who completed tasks using the CDS and (2) the Control group (n = 20), who completed tasks using the standard medication workflow with retrospective manual documentation in our anesthesia information management system. Blinding was not possible. We video- and audio-recorded the participants to capture quantitative data (time on task, mouse clicks, and pixels traveled on the screen) and qualitative data (think-aloud verbalization).
The CDS group mean total task time (402.2 ± 85.9 s) was less than the Control group (509.8 ± 103.6 s), with a mean difference of 107.6 s (95% confidence interval [CI], 60.5-179.5 s, P < .001). The CDS group used fewer mouse clicks (26.4 ± 4.5 clicks) than the Control group (56.0 ± 15.0 clicks) with a mean difference of 29.6 clicks (95% CI, 23.2-37.6, P < .001). The CDS group had fewer pixels traveled on the computer monitor (59.5 ± 20.0 thousand pixels) than the Control group (109.3 ± 40.8 thousand pixels) with a mean difference of 49.8 thousand pixels (95% CI, 33.0-73.7, P < .001).
The perioperative medication-related CDS software prototype substantially outperformed standard EHR workflow by decreasing task time and improving efficiency and quality of care in a simulation setting.
我们开发了一个全面的、与药物相关的临床决策支持（CDS）软件原型，用于手术室。本研究的目的是比较 CDS 软件与当前标准电子健康记录（EHR）药物管理和文档记录工作流程的可用性。
主要结果是完成所有模拟任务所需的时间。次要结果是鼠标点击次数和屏幕上移动的像素总数。将 40 名参与者随机分配到 2 组中的 1 组：（1）CDS 组（n=20），使用 CDS 完成任务；（2）对照组（n=20），使用标准药物工作流程并在我们的麻醉信息管理系统中进行回顾性手动记录。无法进行盲法。我们对参与者进行视频和音频记录，以获取定量数据（任务时间、鼠标点击次数和屏幕上移动的像素数）和定性数据（出声思维口头表达）。
CDS 组的总任务时间（402.2±85.9 秒）明显短于对照组（509.8±103.6 秒），平均差异为 107.6 秒（95%置信区间[CI]，60.5-179.5 秒，P<.001）。CDS 组鼠标点击次数（26.4±4.5 次）明显少于对照组（56.0±15.0 次），平均差异为 29.6 次（95%CI，23.2-37.6，P<.001）。CDS 组在计算机显示器上移动的像素数（59.5±20.0 千像素）明显少于对照组（109.3±40.8 千像素），平均差异为 49.8 千像素（95%CI，33.0-73.7，P<.001）。
在模拟环境中，围手术期与药物相关的 CDS 软件原型通过缩短任务时间以及提高效率和护理质量，显著优于标准 EHR 工作流程。
