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CC BY-NC-ND 4.0 · Appl Clin Inform 2023; 14(01): 28-36
DOI: 10.1055/s-0042-1759866
Research Article

User-Centered Design to Reduce Inappropriate Blood Transfusion Orders

Brad Morse
1   Department of Medicine, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States
,
Tyler Anstett
2   Department of Medicine, Division Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States
,
Neelam Mistry
2   Department of Medicine, Division Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States
,
Samuel Porter
2   Department of Medicine, Division Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States
,
Sharon Pincus
3   Adult & Child Center for Outcomes Research & Delivery Science/The NavLab, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
,
Chen-Tan Lin
1   Department of Medicine, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States
,
Sylvie Novins-Montague
3   Adult & Child Center for Outcomes Research & Delivery Science/The NavLab, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
,
P. Michael Ho
4   Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, United States
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Abstract

Background To improve blood transfusion practices, we applied user-centered design (UCD) to evaluate potential changes to blood transfusion orders.

Objectives The aim of the study is to build effective transfusion orders with different designs to improve guideline adherence.

Methods We developed three different versions of transfusion orders that varied how information was presented to clinicians ordering blood transfusions. We engaged 14 clinicians (residents, advanced practice providers [APPs], and attending physicians) from different specialties. We used the think aloud technique and rapid qualitative analysis to generate themes to incorporate into our modified orders.

Results Most end-users who participated in the semi-structured interviews preferred the interruptive alert design plus behavioral nudges (n = 8/14, 57%). The predominant rationale was that the in-line alert was not visually effective in capturing the end-user's attention, while the interruptive alert forced a brief stop in the workflow to consider the guidelines. All users supported the general improvements, though for different reasons, and as a result, the general improvements remained in the designs for the forthcoming trial.

Conclusion The user experience uncovered through the think aloud approach produced a clear and rich understanding of potentially confounding factors in the initial design of different intervention versions. Input from end-users guided the creation of all three designs so each was addressing human factors with parity, which ensured that the results of our study reflected differences in interruptive properties of the alerts and not differences in design.

Keywords

user-centered design - think aloud - nudge - EHR - user experience - transfusion

Human Subjects Protections

This project was reviewed and categorized as a quality improvement by the Colorado Multiple Institutional Review Board (COMIRB) and was therefore exempt from approval.




Publication History

Received: 28 July 2022

Accepted: 17 October 2022

Article published online:
11 January 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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