Lessons Learned from Implementing a Patient Prioritization Tool Designed with End-Users in a Pediatric Emergency Ward.

INTRODUCTION: Overcrowding is a common problem in emergency departments. This is true for adult and pediatric emergency department (PED) and issues are potentially important (e.g. quality of care, financial, social, ethical). Optimum is one among several solutions implemented to fight this phenomenon. It is an electronic patient prioritization tool for PED devoted to non-vital emergencies. First usage assessments reported the tool was not used by the PED staffs despite their strong involvement during the development. AIM: This paper aims at understanding why the PED staff did not use the Optimum system that has been designed with them and for them, through a user-centered design process. METHOD: PED staffs answered answer a short survey about their usage of Optimum. Depending on their answer (user vs. non-user), they either underwent an individual semi-structured interview or an unstructured one. Interviews were audio-recorded and transcribed and, from each interview, meaningful semantic units representing the reasons for using/non-using Optimum were extracted and organized iteratively following a grounded approach by three ergonomics experts till a consensus was reached. RESULTS: 12 interviews have been performed with 6 physicians, 5 nurses and 1 auxiliary nurse. Overall, the prioritization tool Optimum have received a mixed response from the PED staff: Optimum display is neither understood nor trusted by users. Moreover, it is mainly used to estimate the PED attendance rate and not to prioritize patients. DISCUSSION: This study shows how much it is difficult to implement new tool in wards despite a user-centered development and without being included in the daily used patient management tool.

EHR Usage Problems: A Preliminary Study.

Electronic health record (EHR) systems were initially developed to improve health care delivery by facilitating the healthcare professionals' access to electronically-stored patient information, but problems are regularly reported in the literature. We present here a preliminary study conducted at a 950-bed university hospital. They have implemented an EHR in 2012 to remove their paper-based system. After few years, physicians complain that the EHR is "too complex", "too slow", "unsatisfying", and "which interacts with too many health software". This preliminary study was based on individual interviews inspired from critical incident technique with 9 hospital professionals (physicians and pharmacist) to establish a global diagnostic of the EHR's usability failures/difficulties and their potential impacts. Results show that professionals faced to many constraints impacting their work but more importantly the patient care, with recent outstanding examples. This work is a first step of a larger study to help the hospital to map usability failures, their context of use and associated risks/impacts, and to provide solutions to fix it.

Medication Review: Human Factors Study Aiming at Helping an Acute Geriatric Unit to Sustain and Systematize the Process.

BACKGROUND: Medication Review (MRev) has been implemented in many hospitals to improve patient safety and well-being. However, it seems sometimes difficult to implement, maintain and systematize this process, especially when key-elements are absent. This study focuses on the analysis of a MRev process implemented in an Acute Geriatric Unit (AGU) which, at the time of the study, had no Computerized Physician Order Entry (CPOE) and no sufficient staff to - normally - support the process. OBJECTIVE: This study describes the MRev process as existing in the AGU with a particular focus on the preparatory MRev meeting phase and presents our recommendations to maintain and optimize it. METHODS: Human Factor experts have collected and analyzed data during MRev process by interviews, shadowing observations and video recording from April to October 2014 at Lille University Hospital. RESULTS: MRev process consists of three phases (meeting preparation, MRev meeting and patient discharge) and includes seven main tasks for which actors, documented supports, outcomes and difficulties are identified. Although allocating a fulltime pharmacist for the AGU would solve several problems, the main realistic recommendations concern training for junior and senior actors according to their roles and the improvement of some tasks processes. CONCLUSION: Despite less than optimal conditions as compared to those recommended by the literature, the observed AGU performs an efficient review based on well designed tools and processes.

Design and evaluation of a patient website to reduce crowding in emergency departments: a preliminary study.

The study aims to identify the information useful to support a patients' EDs' choice in order to design a patient Web-based system. For that purpose, a focus group and a formative user test have been performed. The results show that five types of information can be relevant. The spontaneous favored information is the "distance" to EDs. The "Wait time", that is sanctified in literature, is only used in a second time. A larger summative evaluation should be planned to evaluate and validate the befits of this kind of tool.