We aimed to develop and test the usability of a natural language processing-based child abuse CDS system, known as the Child Abuse Clinical Decision Support (CA-CDS), to alert ED clinicians about high-risk injuries suggestive of abuse in infants\' charts.
Informed by available evidence, a multidisciplinary team, including an expert in user design, developed the CA-CDS prototype that provided evidence-based recommendations for the evaluation and management of suspected child abuse when triggered by documentation of a high-risk injury. Content was customized for medical versus nursing providers and initial versus subsequent exposure to the alert. To assess the usability of and refine the CA-CDS, we interviewed 24 clinicians from 4 EDs about their interactions with the prototype. Interview transcripts were coded and analyzed using conventional content analysis.
Overall, 5 main categories of themes emerged from the study. CA-CDS benefits included providing an extra layer of protection, providing evidence-based recommendations, and alerting the entire clinical ED team. The user-centered, workflow-compatible design included soft-stop alert configuration, editable and automatic documentation, and attention-grabbing formatting. Recommendations for improvement included consolidating content, clearer design elements, and adding a hyperlink with additional resources. Barriers to future implementation included alert fatigue, hesitancy to change, and concerns regarding documentation. Facilitators of future implementation included stakeholder buy-in, provider education, and sharing the test characteristics. On the basis of user feedback, iterative modifications were made to the prototype.
With its user-centered design and evidence-based content, the CA-CDS can aid providers in the real-time recognition and evaluation of infant physical abuse and has the potential to reduce the number of missed cases.
目的:我们旨在开发和测试基于自然语言处理的虐待儿童CDS系统的可用性,被称为虐待儿童临床决策支持(CA-CDS),提醒ED临床医生注意暗示婴儿虐待的高危伤害。
方法:根据现有证据,多学科小组,包括用户设计专家,开发了CA-CDS原型,该原型提供了基于证据的建议,用于评估和管理由高风险伤害记录引发的可疑虐待儿童行为。内容是针对医疗与护理提供者以及最初与随后的警报暴露定制的。要评估CA-CDS的可用性并完善CA-CDS,我们采访了来自4个ED的24名临床医生,了解他们与原型的相互作用。使用常规内容分析对访谈记录进行编码和分析。
结果:总体而言,研究中出现了5个主要类别的主题。CA-CDS的好处包括提供额外的保护层,提供基于证据的建议,并提醒整个临床ED团队。以用户为中心,与工作流兼容的设计包括软停止警报配置,可编辑和自动文档,和引人注意的格式。改进建议包括整合内容、更清晰的设计元素,并添加具有额外资源的超链接。未来实施的障碍包括警觉疲劳,犹豫不决地改变,以及对文档的关注。未来实施的促进者包括利益相关者的支持,提供者教育,并分享测试特征。根据用户反馈,对原型进行了迭代修改。
结论:以用户为中心的设计和基于证据的内容,CA-CDS可以帮助提供者实时识别和评估婴儿身体虐待,并有可能减少遗漏病例的数量。