Subscribe to RSS
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/s-0042-1759866
User-Centered Design to Reduce Inappropriate Blood Transfusion Orders
![](https://www.thieme-connect.de/media/10.1055-s-00035026/202301/lookinside/thumbnails/10-1055-s-0042-1759866_202207ra0192-1.jpg)
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.
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/)
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Blecker S, Pandya R, Stork S. et al. Interruptive versus noninterruptive clinical decision support: usability study. JMIR Human Factors 2019; 6 (02) e12469
- 2 Göttgens I, Oertelt-Prigione S. The application of human-centered design approaches in health research and innovation: a narrative review of current practices. JMIR Mhealth Uhealth 2021; 9 (12) e28102
- 3 Brunner J, Chuang E, Goldzweig C, Cain CL, Sugar C, Yano EM. User-centered design to improve clinical decision support in primary care. Int J Med Inform 2017; 104: 56-64
- 4 Colman N, Saldana C, Craig K. et al. Simulation-based user-centered design: an approach to device development during COVID-19. Pediatr Qual Saf 2021; 6 (04) e427
- 5 Clinical Practice Guidelines From the AABB. Red Blood Cell Transfusion Thresholds and Storage | Cardiothoracic Surgery. JAMA. JAMA Network. Accessed June 24, 2022 at: https://jamanetwork.com/journals/jama/article-abstract/2569055
- 6 Rigal JC, Riche VP, Tching-Sin M. et al. Cost of red blood cell transfusion; evaluation in a French academic hospital. Transfus Clin Biol 2020; 27 (04) 222-228
- 7 Accurate costs of blood transfusion: a microcosting of administering blood products in the United Kingdom National Health Service - Stokes - 2018 - Transfusion - Wiley Online Library. Accessed June 24, 2022 at: https://onlinelibrary.wiley.com/doi/full/10.1111/trf.14493
- 8 Activity-based costs of blood transfusions in surgical patients at four hospitals - Shander - 2010 - Transfusion - Wiley Online Library. Accessed June 24, 2022 at: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1537-2995.2009.02518.x
- 9 Trentino KM, Farmer SL, Swain SG. et al. Increased hospital costs associated with red blood cell transfusion. Transfusion 2015; 55 (05) 1082-1089
- 10 Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion - Carson, JL – 2016. Cochrane Library. Accessed June 24, 2022 at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD002042.pub4/full
- 11 Mueller MM, Van Remoortel H, Meybohm P. et al; ICC PBM Frankfurt 2018 Group. Patient blood management: recommendations from the 2018 Frankfurt Consensus Conference. JAMA 2019; 321 (10) 983-997
- 12 Norgaard A, De Lichtenberg TH, Nielsen J, Johansson PI. Monitoring compliance with transfusion guidelines in hospital departments by electronic data capture. Blood Transfus 2014; 12 (04) 509-519
- 13 Ikoma S, Furukawa M, Busuttil A. et al. Optimizing inpatient blood utilization using real-time clinical decision support. Appl Clin Inform 2021; 12 (01) 49-56
- 14 Orenstein EW, Boudreaux J, Rollins M. et al. Formative usability testing reduces severe blood product ordering errors. Appl Clin Inform 2019; Oct; 10 (05) 981-990
- 15 Yarahuan JW, Billet A, Hron JD. A quality improvement initiative to decrease platelet ordering errors and a proposed model for evaluating clinical decision support effectiveness. Appl Clin Inform 2019; 10 (03) 505-512
- 16 Glasgow RE, Knoepke CE, Magid D. et al. The NUDGE trial pragmatic trial to enhance cardiovascular medication adherence: study protocol for a randomized controlled trial. Trials 2021; 22 (01) 528
- 17 Patton MQ. Qualitative Research and Evaluation Methods. 3rd ed. Thousand Oaks, CA: Sage; 2002
- 18 Lewis C. Using the” thinking-aloud” method in cognitive interface design. IBM TJ Watson Research Center. Published online 1982. Accessed July 19, 2021 at: https://dominoweb.draco.res.ibm.com/reports/RC9265.pdf
- 19 Taylor B, Henshall C, Kenyon S, Litchfield I, Greenfield S. Can rapid approaches to qualitative analysis deliver timely, valid findings to clinical leaders? A mixed methods study comparing rapid and thematic analysis. BMJ Open 2018; 8 (10) e019993
- 20 Staccini P, Joubert M, Quaranta JF, Fieschi D, Fieschi M. Integration of health care process analysis in the design of a clinical information system: applying to the blood transfusion process. Proc AMIA Symp 2000; 824-828
- 21 Dzik WH. New technology for transfusion safety. Br J Haematol 2007; 136 (02) 181-190
- 22 Nagtegaal R, Tummers L, Noordegraaf M, Bekkers V. Nudging healthcare professionals towards evidence-based medicine: a systematic scoping review. JBPA 2019; 2(02):
- 23 Orenstein EW, Rollins M, Jones J. et al. Influence of user-centered clinical decision support on pediatric blood product ordering errors. Blood Transfus 2022; (e-pub ahead of print). DOI: 10.2450/2022.0309-21.
- 24 Rowe TA, Brown T, Lee JY. et al. Development and pilot testing of EHR-nudges to reduce overuse in older primary care patients. Arch Gerontol Geriatr 2022; 104: 104794
- 25 Halpern SD. Using default options and other nudges to improve critical care. Crit Care Med 2018; 46 (03) 460-464
- 26 Vaughn VM, Linder JA. Thoughtless design of the electronic health record drives overuse, but purposeful design can nudge improved patient care. BMJ Qual Saf 2018; 27 (08) 583-586
- 27 Kushniruk AW, Patel VL. Cognitive and usability engineering methods for the evaluation of clinical information systems. J Biomed Inform 2004; 37 (01) 56-76