CASE STUDIES

Critical Care Monitoring: Interface for Decision Support Tool

Critical Care Monitoring

The Problem

The Tufts University New England Medical Center developed a logistic regression model designed to help clinicians identify those patients exhibiting symptoms of acute ischemic stroke who can benefit from intravenous thrombolytic therapy. Informatics tools such as this, if well-designed and effectively used, have tremendous potential for helping clinicians make rapid decisions in critical situations, thus improving the quality of health care and enhancing patient safety.

The challenge was to design an interface for this new computer-based decision-support instrument (CDSI) which would fit into the clinical workflow, enabling its acceptance and use by clinicians.

The Solution

Aptima helped develop an interface that clinicians can use effectively in real-time to evaluate patients for thrombolytic therapy. The work was done with our partners, Center for Cardiovascular Health Services Research (CCHSR) in the Division of Clinical Care Research at New England Medical Center, Tufts University, and was funded under a grant from the National Institute of Neurological Disorders and Stroke.

Aptima used a Work-Centered Design process to develop the interface. This process involved in-depth discussions with users, conceptualizing a design, creating a prototype, and evaluation and usability testing in an iterative spiral development process which allowed us to obtain and incorporate feedback from users throughout the process.

Aptima’s end product is a user interface which: (1) aligns with the clinical workflow; (2) supports all users; (3) embeds patient safety checks. The core component of this tool is the patient-selection module, to help select patients with a favorable risk-benefit profile for thrombolytic therapy. This device can potentially also be leveraged to provide other functions, such as a patient-safety module to help ensure protocol compliance and correct dosage administration, a National Institute of Health Stroke Severity (NIHSS) score calculator, a clinical trial support module providing an electronic database and a computerized randomizer, and a documentation module to support physician documentation for the patient record and/or for order entry.

The Results

This product was successfully evaluated for usability and usefulness by expert users from leading hospitals around the country. Overall the physicians found the tool to be both valuable and useful. All participants found the tool to be easy to learn and use.

This tool will help clinicians make better, more informed decisions about patients whose lives may be saved by thrombolytic therapy.