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. 2019 Sep-Oct;19(7):828-834.
doi: 10.1016/j.acap.2019.03.001. Epub 2019 Mar 7.

Impact of Mobile Device-Based Clinical Decision Support Tool on Guideline Adherence and Mental Workload

Katherine M Richardson  1 , Sarah D Fouquet  2 , Ellen Kerns  3 , Russell J McCulloh  3
Affiliations

Impact of Mobile Device-Based Clinical Decision Support Tool on Guideline Adherence and Mental Workload

Katherine M Richardson et al. Acad Pediatr. 2019 Sep-Oct.

Abstract

Objective: To evaluate the individual-level impact of an electronic clinical decision support (ECDS) tool, PedsGuide, on febrile infant clinical decision making and cognitive load.

Methods: A counterbalanced, prospective, crossover simulation study was performed among attending and trainee physicians. Participants performed simulated febrile infant cases with use of PedsGuide and with standard reference text. Cognitive load was assessed using the NASA-Task Load Index (NASA-TLX), which determines mental, physical, temporal demand, effort, frustration, and performance. Usability was assessed with the System Usability Scale (SUS). Scores on cases and NASA-TLX scores were compared between condition states.

Results: A total of 32 participants completed the study. Scores on febrile infant cases using PedsGuide were greater compared with standard reference text (89% vs 72%, P = .001). NASA-TLX scores were lower (ie, more optimal) with use of PedsGuide versus control (mental 6.34 vs 11.8, P < .001; physical 2.6 vs 6.1, P = .001; temporal demand 4.6 vs 8.0, P = .003; performance 4.5 vs 8.3, P < .001; effort 5.8 vs 10.7, P < .001; frustration 3.9 vs 10, P < .001). The SUS had an overall score of 88 of 100 with rating of acceptable on the acceptability scale.

Conclusions: Use of PedsGuide led to increased adherence to guidelines and decreased cognitive load in febrile infant management when compared with the use of a standard reference tool. This study employs a rarely used method of assessing ECDS tools using a multifaceted approach (medical decision-making, assessing usability, and cognitive workload,) that may be used to assess other ECDS tools in the future.

Keywords: electronic clinical decision support; febrile infant; mental workload; pediatrics; usability.

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Figures

Figure 1.
Figure 1.
Consolidated Standards of Reporting Trials diagram of participants recruited and enrolled for study of PedsGuide.
Figure 2.
Figure 2.
Mean percentage on cases with and without use of ECDS. Bars represent standard error. *P=0.001. ECDS indicates electronic clinical decision support.
Figure 3.
Figure 3.
NASA-TLX average scores with and without use of ECDS. Bars represent standard error. Lower score is more optimal indicating less mental, physical, temporal demand, effort, frustration, and better performances. *P<0.01. NASA-TLX indicates NASA-Task load index; and ECDS, electronic clinical decision support
Figure 4.
Figure 4.
System Usability Scale (SUS) average results. Scale 1-5, 1=strongly disagree, 5=strongly agree.
See this image and copyright information in PMC

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