Provider Response to a Venous Thromboembolism Risk Assessment and Prophylaxis Ordering Tool: Observational Study

Abstract

Objectives: Our health system launched an initiative to regulate venous thromboembolism (VTE) risk assessment and prophylaxis with electronically embedded risk assessment models based on validated clinical prediction rules. Prior to system-wide implementation, usability testing was conducted on the VTE clinical decision support system (CDSS) to assess provider perceptions, facilitate adoption, and usage of the tool. The objective of this study was to conduct usability testing with end users on the CDSS' risk assessment model and prophylaxis ordering components.

Methods: This laboratory usability testing study was conducted with 24 health care providers. Participants were given two case scenarios that mirrored real-world scenarios to assess likelihood of use and adoption. During each case scenario, participants engaged in a think-aloud session, verbalizing their decision-making process while interacting with the tool. Following each case scenario, participants completed the System Usability Scale (SUS) and a posttask interview. Participants' comments and interactions with the VTE CDSS were placed into coding categories and analyzed for generalizable themes by three independent coders.

Results: Of the 24 participants, 50% were female and the mean age of all participants was 32.76 years. The average SUS across the different services lines was 72.39 (C grade). Each participant's comments were grouped into three overarching themes: functionality, visibility/navigation, and content. Comments included personalizing workflow for each service line, minimizing the number of clicks, clearly defining risk models, including background on risk scores, and providing treatment guidelines for order sets.

Conclusion: An important step toward providing quality health care to patients at risk of developing a VTE event is providing user-friendly tools to providers. Following usability testing, our study revealed opportunities to positively impact provider behavior and acceptance. The rigor and breadth of this usability testing study and adoption of the optimizations should increase provider adoption and retention of the VTE CDSS.

Fig. 1

International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) risk assessment model and prophylaxis ordering tool. VTE, venous thromboembolism.

Fig. 2

Caprini's risk assessment model.

Fig. 3

Case scenarios. Case scenarios were created for various patient cases based on real-life clinical examples. Starting from the left of the figure to the right, case scenarios reflected venous thromboembolism risk (low, intermediate, or high), weight (within normal limits [WNL] or obese), and renal function (normal, moderately reduced, or severely reduced).

Fig. 4

Areas identified for improvement in the venous thromboembolism (VTE) risk assessment and prophylaxis ordering tool. The red box toward the top of the figure highlights where the risk assessment score displays and the red box toward the bottom highlights the recommended orders pertaining to that risk assessment score. The recommendation elicited from testing was to remove choices as opposed to graying out choices which would lessen distraction for clinicians.