Effects of a computerized feedback intervention on safety performance by junior doctors: results from a randomized...

Area of Science:

• Medical Informatics
• Human-Computer Interaction
• Clinical Decision Support

Background:

• Understanding junior doctor responses to system warnings is crucial for designing effective Clinical Decision Support Systems (CDSS).
• Electronic prescribing and laboratory reporting systems generate hierarchical warnings and alerts.
• This study investigated junior doctor behavior within such a system.

Purpose of the Study:

• To evaluate if a Junior Doctor Dashboard, offering feedback on prescription warning and laboratory alert acceptance, could modify junior doctors' behavior.
• To assess the impact of individualized feedback on safety-related actions.

Main Methods:

• A mixed-methods approach combining a parallel group randomized controlled trial and qualitative interviews.
• Junior doctors were randomized into an intervention group receiving weekly dashboard feedback and a control group.
• Outcome measures included changes in responses to prescribing and laboratory alerts before and during the intervention period.

Main Results:

• No significant differences were found in generating prescription warnings or accepting laboratory alarms between groups.
• However, responses to laboratory alerts improved significantly in the intervention group for Foundation Year 1 doctors (p=0.002).
• Qualitative data revealed junior doctors selectively responded to alerts based on perceived clinical relevance and responsibility.

Conclusions:

• Individualized feedback via a clinical dashboard shows limited potential to enhance safety behavior, specifically in laboratory alert response.
• The effectiveness of clinical dashboards is contingent on aligning their metrics with actual clinical work processes.
• Further research is needed to optimize CDSS design based on user behavior and workflow integration.