Angela Mastrianni
Aleksandra Sarcevic
ABSTRACT
Decision support alerts have the potential to assist clinicians in determining appropriate interventions for critically injured patients. The design of these alerts is critical because it can impact their adoption and effectiveness. In this late-breaking work, we explore how decision support alerts should be designed for cognitive aids used in time- and safety-critical medical events. We conducted interviews with 11 trauma team leaders to elicit their thoughts and reactions to potential alert designs. From the findings, we contribute three implications for designing alerts for cognitive aids that support team-based, time-critical decision making and discuss how these implications can be further explored in future work.
Supplemental Material
- Eva Brandt. 2007. How tangible mock-ups support design collaboration. Knowledge, Technology & Policy 20, 3 (2007), 179–192.Google Scholar
Cross Ref
- Barbara K Burian, Anna Clebone, Key Dismukes, and Keith J Ruskin. 2018. More than a tick box: medical checklist development, design, and use. Anesthesia & Analgesia 126, 1 (2018), 223–232.Google ScholarCross Ref
- Vanessa Cobus, Hannah Meyer, Swamy Ananthanarayan, Susanne Boll, and Wilko Heuten. 2018. Towards reducing alarm fatigue: peripheral light pattern design for critical care alarms. In Proceedings of the 10th Nordic Conference on Human-Computer Interaction. 654–663.Google ScholarDigital Library
- American College of Surgeons Committee on Trauma. 2018. Advanced Trauma Life Support ATLS: Student Course Manual (10th ed.). American College of Surgeons.Google Scholar
- Norman Lance Downing, Joshua Rolnick, Sarah F Poole, Evan Hall, Alexander J Wessels, Paul Heidenreich, and Lisa Shieh. 2019. Electronic health record-based clinical decision support alert for severe sepsis: a randomised evaluation. BMJ quality & safety 28, 9 (2019), 762–768.Google Scholar
- Eric Dryver, Jakob Lundager Forberg, Caroline Hård af Segerstad, William D Dupont, Anders Bergenfelz, and Ulf Ekelund. 2021. Medical crisis checklists in the emergency department: a simulation-based multi-institutional randomised controlled trial. BMJ Quality & Safety(2021).Google Scholar
- Alexander G Fiks, Robert W Grundmeier, Stephanie Mayne, Lihai Song, Kristen Feemster, Dean Karavite, Cayce C Hughes, James Massey, Ron Keren, Louis M Bell, 2013. Effectiveness of decision support for families, clinicians, or both on HPV vaccine receipt. Pediatrics 131, 6 (2013), 1114–1124.Google ScholarCross Ref
- Ulla H Graneheim and Berit Lundman. 2004. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse education today 24, 2 (2004), 105–112.Google Scholar
- Tobias Grundgeiger, Stephan Huber, Daniel Reinhardt, Andreas Steinisch, Oliver Happel, and Thomas Wurmb. 2019. Cognitive aids in acute care: Investigating how cognitive aids affect and support in-hospital emergency teams. In Proceedings of the 2019 CHI Conference on Human Factors in Computing Systems. 1–14.Google ScholarDigital Library
- Nicolai Brodersen Hansen, Christian Dindler, Kim Halskov, Ole Sejer Iversen, Claus Bossen, Ditte Amund Basballe, and Ben Schouten. 2019. How participatory design works: mechanisms and effects. In Proceedings of the 31st Australian Conference on Human-Computer-Interaction. 30–41.Google ScholarDigital Library
- Christopher Hicks and Andrew Petrosoniak. 2018. The human factor: optimizing trauma team performance in dynamic clinical environments. Emergency Medicine Clinics 36, 1 (2018), 1–17.Google ScholarCross Ref
- Mustafa I Hussain, Ariana M Nelson, Brent G Yeung, Lauren Sukumar, and Kai Zheng. 2020. How the presentation of patient information and decision-support advisories influences opioid prescribing behavior: A simulation study. Journal of the American Medical Informatics Association 27, 4(2020), 613–620.Google ScholarCross Ref
- Erika Johannessen, Adam Szulewski, Nada Radulovic, Matthew White, Heather Braund, Dan Howes, Dirk Rodenburg, and Claire Davies. 2020. Psychophysiologic measures of cognitive load in physician team leaders during trauma resuscitation. Computers in Human Behavior 111 (2020), 106393.Google ScholarCross Ref
- Annika Kaltenhauser, Verena Rheinstädter, Andreas Butz, and Dieter P Wallach. 2020. ”You Have to Piece the Puzzle Together” Implications for Designing Decision Support in Intensive Care. In Proceedings of the 2020 ACM Designing Interactive Systems Conference. 1509–1522.Google ScholarDigital Library
- Sara Klüber, Franzisca Maas, David Schraudt, Gina Hermann, Oliver Happel, and Tobias Grundgeiger. 2020. Experience Matters: Design and Evaluation of an Anesthesia Support Tool Guided by User Experience Theory. In Proceedings of the 2020 ACM Designing Interactive Systems Conference. 1523–1535.Google ScholarDigital Library
- Leah Kulp, Aleksandra Sarcevic, Richard Farneth, Omar Ahmed, Dung Mai, Ivan Marsic, and Randall S Burd. 2017. Exploring design opportunities for a context-adaptive medical checklist through technology probe approach. In Proceedings of the 2017 Conference on Designing Interactive Systems. 57–68.Google ScholarDigital Library
- Leah Kulp, Aleksandra Sarcevic, Yinan Zheng, Megan Cheng, Emily Alberto, and Randall Burd. 2020. Checklist design reconsidered: Understanding checklist compliance and timing of interactions. In Proceedings of the 2020 CHI Conference on Human Factors in Computing Systems. 1–13.Google ScholarDigital Library
- Pei-Yi Kuo, Rajiv Saran, Marissa Argentina, Michael Heung, Jennifer L Bragg-Gresham, Dinesh Chatoth, Brenda Gillespie, Sarah Krein, Rebecca Wingard, Kai Zheng, 2019. Development of a checklist for the prevention of intradialytic hypotension in hemodialysis care: Design considerations based on activity theory. In Proceedings of the 2019 CHI Conference on Human Factors in Computing Systems. 1–14.Google ScholarDigital Library
- Simon YW Li, Farah Magrabi, and Enrico Coiera. 2012. A systematic review of the psychological literature on interruption and its patient safety implications. Journal of the American Medical Informatics Association 19, 1(2012), 6–12.Google ScholarCross Ref
- Stuart Marshall. 2013. The use of cognitive aids during emergencies in anesthesia: a review of the literature. Anesthesia & Analgesia 117, 5 (2013), 1162–1171.Google ScholarCross Ref
- Stuart D Marshall. 2017. Helping experts and expert teams perform under duress: an agenda for cognitive aid research. Anaesthesia 72, 3 (2017), 289.Google ScholarCross Ref
- Angela Mastrianni, Lynn Almengor, and Aleksandra Sarcevic. 2022. Alerts as Coordination Mechanisms: Implications for Designing Alerts for Multidisciplinary and Shared Decision Making. Proceedings of the ACM on Human-Computer Interaction 6, GROUP(2022), 1–14.Google ScholarDigital Library
- Angela Mastrianni, Aleksandra Sarcevic, Lauren Chung, Issa Zakeri, Emily Alberto, Zachary Milestone, Ivan Marsic, and Randall S Burd. 2021. Designing Interactive Alerts to Improve Recognition of Critical Events in Medical Emergencies. In Designing Interactive Systems Conference 2021. 864–878.Google ScholarDigital Library
- D Scott McCrickard, Michael E Atwood, Gayle Curtis, Steve Harrison, Jon Kolko, Erik Stolterman, and Shahtab Wahid. 2010. Artifacts in design: Representation, ideation, and process. In CHI’10 Extended Abstracts on Human Factors in Computing Systems. 4445–4448.Google Scholar
- John D McGreevey III, Colleen P Mallozzi, Randa M Perkins, Eric Shelov, and Richard Schreiber. 2020. Reducing alert burden in electronic health records: state of the art recommendations from four health systems. Applied clinical informatics 11, 01 (2020), 001–012.Google Scholar
- Annette Moxey, Jane Robertson, David Newby, Isla Hains, Margaret Williamson, and Sallie-Anne Pearson. 2010. Computerized clinical decision support for prescribing: provision does not guarantee uptake. Journal of the American Medical Informatics Association 17, 1(2010), 25–33.Google ScholarCross Ref
- Karen C Nanji, Diane L Seger, Sarah P Slight, Mary G Amato, Patrick E Beeler, Qoua L Her, Olivia Dalleur, Tewodros Eguale, Adrian Wong, Elizabeth R Silvers, 2018. Medication-related clinical decision support alert overrides in inpatients. Journal of the American Medical Informatics Association 25, 5(2018), 476–481.Google ScholarCross Ref
- JaeYeon Park, Soyoung Rhim, Kyungsik Han, and JeongGil Ko. 2021. Disentangling the clinical data chaos: User-centered interface system design for trauma centers. Plos one 16, 5 (2021), e0251140.Google ScholarCross Ref
- Emily M Powers, Richard N Shiffman, Edward R Melnick, Andrew Hickner, and Mona Sharifi. 2018. Efficacy and unintended consequences of hard-stop alerts in electronic health record systems: a systematic review. Journal of the American Medical Informatics Association 25, 11(2018), 1556–1566.Google ScholarCross Ref
- Gerald Sendlhofer, Nina Mosbacher, Leitgeb Karina, Brigitte Kober, Lydia Jantscher, Andrea Berghold, Gudrun Pregartner, Gernot Brunner, and Lars Peter Kamolz. 2015. Implementation of a surgical safety checklist: interventions to optimize the process and hints to increase compliance. PLoS One 10, 2 (2015), e0116926.Google ScholarCross Ref
- Reed T Sutton, David Pincock, Daniel C Baumgart, Daniel C Sadowski, Richard N Fedorak, and Karen I Kroeker. 2020. An overview of clinical decision support systems: benefits, risks, and strategies for success. NPJ digital medicine 3, 1 (2020), 1–10.Google Scholar
- Charat Thongprayoon, Andrew M Harrison, John C O’Horo, Ronaldo A Sevilla Berrios, Brian W Pickering, and Vitaly Herasevich. 2016. The effect of an electronic checklist on critical care provider workload, errors, and performance. Journal of intensive care medicine 31, 3 (2016), 205–212.Google ScholarCross Ref
- Annette L Valenta, Margaret M Browning, Timothy E Weddle, Greer WP Stevenson, Andrew D Boyd, and Denise M Hynes. 2010. Physician perceptions of clinical reminders. In Proceedings of the 1st ACM International Health Informatics Symposium. 710–717.Google ScholarDigital Library
- Dakuo Wang, Liuping Wang, Zhan Zhang, Ding Wang, Haiyi Zhu, Yvonne Gao, Xiangmin Fan, and Feng Tian. 2021. “Brilliant AI Doctor” in Rural Clinics: Challenges in AI-Powered Clinical Decision Support System Deployment. In Proceedings of the 2021 CHI Conference on Human Factors in Computing Systems. 1–18.Google ScholarDigital Library
- Abigail R Wooldridge, Pascale Carayon, Peter Hoonakker, Bat-Zion Hose, Joshua Ross, Jonathan E Kohler, Thomas Brazelton, Benjamin Eithun, Michelle M Kelly, Shannon M Dean, 2019. Complexity of the pediatric trauma care process: implications for multi-level awareness. Cognition, Technology & Work 21, 3 (2019), 397–416.Google ScholarDigital Library
- Qian Yang, John Zimmerman, Aaron Steinfeld, Lisa Carey, and James F Antaki. 2016. Investigating the heart pump implant decision process: opportunities for decision support tools to help. In Proceedings of the 2016 CHI Conference on Human Factors in Computing Systems. 4477–4488.Google ScholarDigital Library
- Dolma Yangchen Sherpa, Angela Mastrianni, and Aleksandra Sarcevic. 2021. Exploring the Design of Streaming Data Interfaces for Emergency Medical Contexts. In Adjunct Publication of the 23rd International Conference on Mobile Human-Computer Interaction. 1–6.Google Scholar
Recommendations
Designing Interactive Alerts to Improve Recognition of Critical Events in Medical Emergencies
DIS '21: Proceedings of the 2021 ACM Designing Interactive Systems ConferenceVital sign values during medical emergencies can help clinicians recognize and treat patients with life-threatening injuries. Identifying abnormal vital signs, however, is frequently delayed and the values may not be documented at all. In this mixed-...
Transitioning Cognitive Aids into Decision Support Platforms: Requirements and Design Guidelines
Digital cognitive aids have the potential to serve as clinical decision support platforms, triggering alerts about process delays and recommending interventions. In this mixed-methods study, we examined how a digital checklist for pediatric trauma ...
Alerts as Coordination Mechanisms: Implications for Designing Alerts for Multidisciplinary and Shared Decision Making
GROUPIn this study, we explore how clinical decision support features can be designed to aid teams in caring for patients during time-critical medical emergencies. We interviewed 12 clinicians with experience in leading pediatric trauma resuscitations to ...
Comments