Start Submission Become a Reviewer

Reading: Back to the Bedside: Developing a Bedside Aid for Concussion and Brain Injury Decisions in t...

Download

A- A+
dyslexia friendly

Case study

Back to the Bedside: Developing a Bedside Aid for Concussion and Brain Injury Decisions in the Emergency Department

Authors:

Edward R. Melnick ,

Yale School of Medicine
X close

Kevin Lopez,

University of Connecticut
X close

Erik P. Hess,

Mayo Clinic
X close

Fuad Abujarad,

Yale School of Medicine
X close

Cynthia A. Brandt,

Yale School of Medicine
X close

Richard N. Shiffman,

Yale School of Medicine
X close

Lori A. Post

Yale School of Medicine
X close

Abstract

Context: Current information-rich electronic health record (EHR) interfaces require large, high-resolution screens running on desktop computers. This interface compromises the provider’s already limited time at the bedside by physically separating the patient from the doctor. The case study presented here describes a patient-centered clinical decision support (CDS) design process that aims to bring the physician back to the bedside by integrating a patient decision aid with CDS for shared use by the patient and provider on a touchscreen tablet computer for deciding whether or not to obtain a CT scan for minor head injury in the emergency department, a clinical scenario that could benefit from CDS but has failed previous implementation attempts.

Case Description: This case study follows the user-centered design (UCD) approach to build a bedside aid that is useful and usable, and that promotes shared decision-making between patients and their providers using a tablet computer at the bedside. The patient-centered decision support design process focuses on the prototype build using agile software development, but also describes the following: (1) the requirement gathering phase including triangulated qualitative research (focus groups and cognitive task analysis) to understand current challenges, (2) features for patient education, the physician, and shared decision-making, (3) system architecture and technical requirements, and (4) future plans for formative usability testing and field testing.

Lessons Learned: We share specific lessons learned and general recommendations from critical insights gained in the patient-centered decision support design process about early stakeholder engagement, EHR integration, external expert feedback, challenges to two users on a single device, project management, and accessibility.

Conclusions: Successful implementation of this tool will require seamless integration into the provider’s workflow. This protocol can create an effective interface for shared decision-making and safe resource reduction at the bedside in the austere and dynamic clinical environment of the ED and is generalizable for these purposes in other clinical environments as well.

How to Cite: Melnick ER, Lopez K, Hess EP, Abujarad F, Brandt CA, Shiffman RN, et al.. Back to the Bedside: Developing a Bedside Aid for Concussion and Brain Injury Decisions in the Emergency Department. eGEMs (Generating Evidence & Methods to improve patient outcomes). 2015;3(2):6. DOI: http://doi.org/10.13063/2327-9214.1136
1
Views
Published on 29 Jun 2015.
Peer Reviewed

Downloads

  • PDF (EN)