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Web based decision support tools for maternity: reducing risks by designing errors out of clinical decision processes

Carole-Anne Whigham1, Fiona Lewis2, Natalie Albertyn2, Thabani Sibanda2

1. Frankston Hospital, Hastings Road, Frankston, Victoria, Australia2. Hutt Hospital, Hutt Valley DHB, Lower Hutt, Wellington, New Zealand

Objectives

Human error in healthcare is inevitable1. To mitigate this, “we must re-examine all that we do and redesign our many and complex systems to make them less vulnerable to human error”2.

Our objective was to develop and evaluate a set of electronic decision support tools for selected well known error prone areas of common maternity encounters. The tools would reduce the chances of error by automating and simplifying key information processing tasks, using readily available computer resources.

Methods

Key recommendations from two RCOG and NICE clinical guidelines (Chicken Pox3, and Electronic Fetal Monitoring4) were extracted and exported onto Microsoft Excel (MS Excel).

MS Excel based intuitive interactive tools were then developed, transformed into web (html) files, and placed on a local computer.

A 15 person panel of Obstetrics Registrars and Midwives evaluated the tool, using a five-item response scale measuring their levels of agreement with statements on; accessibility, user friendliness, accuracy, usefulness in clinical practice, speed, and whether they were likely to use such tools again in future.

Results

There was unanimous support for the tools, with all areas assessed scoring positively.

Conclusions

References

We have demonstrated the feasibility of redesigning a set of sometimes complex systems (clinical guidelines), into easy to use tools that have the potential to make that system less vulnerable to human error.

These electronic decision aids, based on evidence based guidelines, can support the full and longer versions of the guidelines (paper or electronic). They are user friendly, are interactive, and were deliberately created to improve access to key recommendations within the full clinical guidelines, and to reduce complexity that often accompanies the use of long versions of these guidelines. The approach aimed to utilize already existing computer resources within our labour wards.

The techniques and approach used here can be extended to cover many other clinical guidelines on various clinical conditions, from different areas of care.

OPTIONALLOGO HERE

References1. Kohn LT, Corrigan J, Donaldson MS. To err is human: building a safer health system. Washington, D.C. ; [Great Britain]: National Academy Press, 2000.2. Leape LL, Berwick DM. Safe health care: are we up to it? BMJ 2000;320(7237):725-6.3. Chickenpox in Pregnancy (Green-top 13), 2007; RCOG, RCOG Press4. Intrapartum care: management and delivery of care to women in labour, Clinical guidelines, CG55; September 2007; National Collaborating Centre for Women’s and Children’s Health; RCOG Press5. Doc-Aids.Com: Clinical Decision Aids & Calculators for Doctors. www.doc-aids.com)

Chicken PoxStrongly Disagree

DisagreeNeither

Disagree Nor Agree

AgreeStrongly

Agree

This system improves access to relevant guidance

  1 14

This system is user friendly   6 9

This system gives accurate results

  3 12

This system is useful for clinical practice

  2 13

The speed is about right   7 8

I would use such a system in future

      15

CTG Interpretation Strongly Disagree

DisagreeNeither

Disagree Nor Agree

AgreeStrongly

Agree

This system improves access to relevant guidance

  2 13

This system is user friendly   1 14

This system gives accurate results

  4 11

This system is useful for clinical practice

  1 14

The speed is about right   5 10

I would use such a system in future

      15

Case Scenario (Example)

Patient: •Chicken Pox contact, 22 weeks pregnant

Doctor: •Wishes to confirm what action to take ..•Looks for clinical guidelines

Comments (Feedback)

•“if information is regularly updated and evidence based then this would be an excellent tool to assist decision making in practice...“•"the information is easily and quickly accessed ...“•"that was great ...“

Clinical guidelines

Local paper guidelines

RCOG guidelines3

•Chicken Pox: Page 3 (section 4.3) 3

‘In the pregnant woman who gives a history of contact with chickenpox or shingles’