Pondicherry Neha, Schwartz Hope, Stark Nicholas, Dhanoa Jaskirat, Emanuels David, Singh Malini, Peabody Christopher R
School of Medicine University of California San Francisco California USA.
Department of Emergency Medicine University of California San Francisco California USA.
J Am Coll Emerg Physicians Open. 2023 Mar 7;4(2):e12919. doi: 10.1002/emp2.12919. eCollection 2023 Apr.
Clinical guidelines are evidence-based clinician decision-support tools that improve health outcomes, reduce patient harm, and decrease healthcare costs, but are often underused in emergency departments (EDs). This article describes a replicable, evidence-based design-thinking approach to developing best practices for guideline design that improves clinical satisfaction and usage. We used a 5-step process to enhance guideline usability in our ED. First, we conducted end-user interviews to identify barriers to guideline usage. Second, we reviewed the literature to identify key principles in guideline design. Third, we applied our findings to create a standardized guideline format, incorporating rapid cycle learning and iterative improvements. Fourth, we ensured the clinical validity of our updated guidelines by using a rigorous process for peer review. Lastly, we evaluated the impact of our guideline conversion process by tracking clinical guidelines access per day from October 2020 to January 2022. Our end-user interviews and review of the design literature revealed several barriers to guideline use, including lack of readability, design inconsistencies, and guideline complexity. Although our previous clinical guideline system averaged 0.13 users per day, >43 users per day accessed the clinical guidelines on our new digital platform in January 2022, representing an increase in access and use exceeding 33,000%. Our replicable process using open-access resources increased clinician access to and satisfaction with clinical guidelines in our ED. Design-thinking and use of low-cost technology can significantly improve clinical guideline visibility and has the potential to increase guideline use.
临床指南是以证据为基础的临床医生决策支持工具，可改善健康结局、减少患者伤害并降低医疗成本，但在急诊科（ED）中常常未得到充分利用。本文描述了一种可复制的、基于证据的设计思维方法，用于制定指南设计的最佳实践，以提高临床满意度和使用率。我们采用了一个五步流程来提高我们急诊科指南的可用性。首先，我们进行了终端用户访谈，以确定指南使用的障碍。其次，我们查阅了文献，以确定指南设计的关键原则。第三，我们将研究结果应用于创建标准化的指南格式，纳入快速循环学习和迭代改进。第四，我们通过严格的同行评审流程确保更新后的指南具有临床有效性。最后，我们通过跟踪2020年10月至2022年1月期间每天的临床指南访问量，评估了我们指南转换过程的影响。我们的终端用户访谈和对设计文献的回顾揭示了指南使用的几个障碍，包括缺乏可读性、设计不一致和指南复杂性。尽管我们之前的临床指南系统平均每天有0.13个用户，但在2022年1月，每天有超过43个用户访问我们新数字平台上的临床指南，访问量和使用率增长超过33000%。我们使用开放获取资源的可复制流程增加了临床医生对我们急诊科临床指南的访问并提高了满意度。设计思维和低成本技术的使用可以显著提高临床指南的可见性，并有可能增加指南的使用。
