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

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

Acad Pediatr. 2019 Mar 07;:

Authors: Richardson KM, Fouquet SD, Kerns E, McCulloh RJ

Abstract
OBJECTIVE: To evaluate the individual-level impact of an electronic clinical support (ECDS) tool, PedsGuide, on febrile infant clinical decision making and cognitive load.
METHODS: A counterbalanced, prospective, cross-over simulation study was performed amongst 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 higher compared to standard reference text (89% vs. 72%, p=0.001). NASA-TLX scores were lower (i.e. more optimal) with use of PedsGuide vs. control (mental 6.34 vs. 11.8, p<0.001; physical 2.6 vs. 6.1, p=0.001; temporal demand 4.6 vs. 8.0, p=0.003; performance 4.5 vs. 8.3, p<0.001; effort 5.8 vs. 10.7, p<0.001; frustration (3.9 vs. 10, p<0.001). The SUS had an overall score of 88 out 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 to use of a standard reference tool. This study employs a rarely used method of assessing ECDS tools using a multi-faceted approach (medical decision-making, assessing usability, and cognitive workload,) that may be utilized to assess other ECDS tools in the future.

PMID: 30853573 [PubMed - as supplied by publisher]