Informing the design of clinical decision support services for evaluation of children with minor blunt head trauma in the emergency department: A sociotechnical analysis

Barbara Sheehan, Lise E. Nigrovic, Peter S. Dayan, Nathan Kuppermann, Dustin W. Ballard, Evaline Alessandrini, Lalit Bajaj, Howard Goldberg, Jeffrey Hoffman, Steven R. Offerman, Dustin G. Mark, Marguerite Swietlik, Eric Tham, Leah S Tzimenatos, David R. Vinson, Grant S. Jones, Suzanne Bakken

Research output: Contribution to journalArticle

37 Scopus citations

Abstract

Integration of clinical decision support services (CDSS) into electronic health records (EHRs) may be integral to widespread dissemination and use of clinical prediction rules in the emergency department (ED). However, the best way to design such services to maximize their usefulness in such a complex setting is poorly understood. We conducted a multi-site cross-sectional qualitative study whose aim was to describe the sociotechnical environment in the ED to inform the design of a CDSS intervention to implement the Pediatric Emergency Care Applied Research Network (PECARN) clinical prediction rules for children with minor blunt head trauma. Informed by a sociotechnical model consisting of eight dimensions, we conducted focus groups, individual interviews and workflow observations in 11 EDs, of which 5 were located in academic medical centers and 6 were in community hospitals. A total of 126 ED clinicians, information technology specialists, and administrators participated. We clustered data into 19 categories of sociotechnical factors through a process of thematic analysis and subsequently organized the categories into a sociotechnical matrix consisting of three high-level sociotechnical dimensions (workflow and communication, organizational factors, human factors) and three themes (interdisciplinary assessment processes, clinical practices related to prediction rules, EHR as a decision support tool). Design challenges that emerged from the analysis included the need to use structured data fields to support data capture and re-use while maintaining efficient care processes, supporting interdisciplinary communication, and facilitating family-clinician interaction for decision-making.

Original languageEnglish (US)
Pages (from-to)905-913
Number of pages9
JournalJournal of Biomedical Informatics
Volume46
Issue number5
DOIs
StatePublished - Oct 2013

    Fingerprint

Keywords

  • Clinical decision support
  • Emergency department
  • Pediatrics
  • Prediction rules
  • Traumatic brain injury

ASJC Scopus subject areas

  • Computer Science Applications
  • Health Informatics

Cite this

Sheehan, B., Nigrovic, L. E., Dayan, P. S., Kuppermann, N., Ballard, D. W., Alessandrini, E., Bajaj, L., Goldberg, H., Hoffman, J., Offerman, S. R., Mark, D. G., Swietlik, M., Tham, E., Tzimenatos, L. S., Vinson, D. R., Jones, G. S., & Bakken, S. (2013). Informing the design of clinical decision support services for evaluation of children with minor blunt head trauma in the emergency department: A sociotechnical analysis. Journal of Biomedical Informatics, 46(5), 905-913. https://doi.org/10.1016/j.jbi.2013.07.005