Jacob K Greenberg1, Ayodamola Otun1, Pyi Theim Kyaw2, Christopher R Carpenter3, Ross C Brownson4, Nathan Kuppermann5, David D Limbrick1, Randi E Foraker6, Po-Yin Yen6. 1. Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States. 2. McKelvey School of Engineering, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States. 3. Department of Emergency Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States. 4. Brown School of Social Work, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States. 5. Department of Emergency Medicine, University of California Davis, Davis, California, United States. 6. Institute for Informatics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States.
Abstract
BACKGROUND: The Kids Intracranial Injury Decision Support tool for Traumatic Brain Injury (KIIDS-TBI) tool is a validated risk prediction model for managing children with mild traumatic brain injuries (mTBI) and intracranial injuries. Electronic clinical decision support (CDS) may facilitate the clinical implementation of this evidence-based guidance. OBJECTIVE: Our objective was to evaluate the acceptability and usability of an electronic CDS tool for managing children with mTBI and intracranial injuries. METHODS: Emergency medicine and neurosurgery physicians (10 each) from 10 hospitals in the United States were recruited to participate in usability testing of a novel CDS prototype in a simulated electronic health record environment. Testing included a think-aloud protocol, an acceptability and usability survey, and a semi-structured interview. The prototype was updated twice during testing to reflect user feedback. Usability problems recorded in the videos were categorized using content analysis. Interview transcripts were analyzed using thematic analysis. RESULTS: Among the 20 participants, most worked at teaching hospitals (80%), freestanding children's hospitals (95%), and level-1 trauma centers (75%). During the two prototype updates, problems with clarity of terminology and navigating through the CDS interface were identified and corrected. Corresponding to these changes, the number of usability problems decreased from 35 in phase 1 to 8 in phase 3 and the number of mistakes made decreased from 18 (phase 1) to 2 (phase 3). Through the survey, participants found the tool easy to use (90%), useful for determining a patient's level of care (95%), and likely to improve resource use (90%) and patient safety (79%). Interview themes related to the CDS's ability to support evidence-based decision-making and improve clinical workflow proposed implementation strategies and potential pitfalls. CONCLUSION: After iterative evaluation and refinement, the KIIDS-TBI CDS tool was found to be highly usable and useful for aiding the management of children with mTBI and intracranial injuries. Thieme. All rights reserved.
BACKGROUND: The Kids Intracranial Injury Decision Support tool for Traumatic Brain Injury (KIIDS-TBI) tool is a validated risk prediction model for managing children with mild traumatic brain injuries (mTBI) and intracranial injuries. Electronic clinical decision support (CDS) may facilitate the clinical implementation of this evidence-based guidance. OBJECTIVE: Our objective was to evaluate the acceptability and usability of an electronic CDS tool for managing children with mTBI and intracranial injuries. METHODS: Emergency medicine and neurosurgery physicians (10 each) from 10 hospitals in the United States were recruited to participate in usability testing of a novel CDS prototype in a simulated electronic health record environment. Testing included a think-aloud protocol, an acceptability and usability survey, and a semi-structured interview. The prototype was updated twice during testing to reflect user feedback. Usability problems recorded in the videos were categorized using content analysis. Interview transcripts were analyzed using thematic analysis. RESULTS: Among the 20 participants, most worked at teaching hospitals (80%), freestanding children's hospitals (95%), and level-1 trauma centers (75%). During the two prototype updates, problems with clarity of terminology and navigating through the CDS interface were identified and corrected. Corresponding to these changes, the number of usability problems decreased from 35 in phase 1 to 8 in phase 3 and the number of mistakes made decreased from 18 (phase 1) to 2 (phase 3). Through the survey, participants found the tool easy to use (90%), useful for determining a patient's level of care (95%), and likely to improve resource use (90%) and patient safety (79%). Interview themes related to the CDS's ability to support evidence-based decision-making and improve clinical workflow proposed implementation strategies and potential pitfalls. CONCLUSION: After iterative evaluation and refinement, the KIIDS-TBI CDS tool was found to be highly usable and useful for aiding the management of children with mTBI and intracranial injuries. Thieme. All rights reserved.
Authors: Katie E Neumayer; Jill Sweney; Stephen J Fenton; Heather T Keenan; Brian F Flaherty Journal: J Pediatr Surg Date: 2019-10-24 Impact factor: 2.545
Authors: Jacob K Greenberg; Donna B Jeffe; Christopher R Carpenter; Yan Yan; Jose A Pineda; Angela Lumba-Brown; Martin S Keller; Daniel Berger; Robert J Bollo; Vijay M Ravindra; Robert P Naftel; Michael C Dewan; Manish N Shah; Erin C Burns; Brent R O'Neill; Todd C Hankinson; William E Whitehead; P David Adelson; Mandeep S Tamber; Patrick J McDonald; Edward S Ahn; William Titsworth; Alina N West; Ross C Brownson; David D Limbrick Journal: J Neurosurg Pediatr Date: 2018-10-26 Impact factor: 2.375
Authors: Jacob K Greenberg; Ivan T Stoev; Tae Sung Park; Matthew D Smyth; Jeffrey R Leonard; Julie C Leonard; Jose A Pineda; David D Limbrick Journal: J Trauma Acute Care Surg Date: 2014-04 Impact factor: 3.313
Authors: Jacob K Greenberg; Ranbir Ahluwalia; Madelyn Hill; Gabbie Johnson; Andrew T Hale; Ahmed Belal; Shawyon Baygani; Margaret A Olsen; Randi E Foraker; Christopher R Carpenter; Yan Yan; Laurie Ackerman; Corina Noje; Eric Jackson; Erin Burns; Christina M Sayama; Nathan R Selden; Shobhan Vachhrajani; Chevis N Shannon; Nathan Kuppermann; David D Limbrick Journal: Acad Emerg Med Date: 2021-08-06 Impact factor: 3.451