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Assessing the electronic Bedside Paediatric Early Warning System: A simulation study on decision-making and usability
Jessica N Tomasi1, Megan V Hamilton2, Mark Fan1
1HumanEra, Office of Research and Innovation, North York General Hospital, 4001 Leslie Street, LE-140, North York, ON, Canada.
Insights
The Bedside Paediatric Early Warning System (BedsidePEWS) improves pediatric patient care. Electronic BedsidePEWS demonstrated superior usability and adherence to care recommendations compared to paper versions and electronic health records.
Area of Science:
- Pediatric critical care medicine
- Clinical decision support systems
- Health informatics
Background:
- The Bedside Paediatric Early Warning System (BedsidePEWS) is a tool to identify deteriorating children and standardize care.
- Previous studies show paper BedsidePEWS improves clinician perception, but empirical data on its impact is limited.
- The transition to electronic systems necessitates evaluating the impact of electronic BedsidePEWS on clinician performance and user experience.
Purpose of the Study:
- To compare adherence to evidence-based care recommendations using electronic health records, paper BedsidePEWS, and electronic BedsidePEWS.
- To assess end-users' experiences with the usability of both paper and electronic BedsidePEWS.
- To identify areas for improvement in BedsidePEWS implementation.
Main Methods:
- Paediatric nurses participated in a repeated measures simulation study.
- Nurses assessed simulated patients across three conditions: electronic health record, paper BedsidePEWS, and electronic BedsidePEWS.
- Usability feedback was collected through post-simulation questionnaires and comments.
Main Results:
- Both paper and electronic BedsidePEWS led to significantly more appropriate care decisions than electronic health records.
- Electronic BedsidePEWS showed a 15.7% reduction in calculation errors compared to paper.
- Participants preferred electronic BedsidePEWS, citing benefits like automatic score calculation and data plotting.
Conclusions:
- BedsidePEWS, in both paper and electronic formats, enhances the detection of deterioration and adherence to care recommendations compared to standard EHRs.
- Electronic BedsidePEWS offers superior usability and care improvement potential over the paper version.
- Electronic BedsidePEWS can further standardize and improve pediatric care in community settings.
Background:
The Bedside Paediatric Early Warning System (BedsidePEWS) is a clinical decision support tool designed to augment clinician expertise, objectively identify children at risk for clinical deterioration, and standardize and prioritize care to improve outcomes in community settings. Although the paper-based BedsidePEWS documentation record has been shown to improve clinicians' perception of their ability to detect deterioration and follow care recommendations, research is needed to asses this impact empirically. Furthermore, as hospitals progressively move toward electronic clinical systems, knowledge regarding the impact of BedsidePEWS' novel electronic interface on clinicians' performance and user experience is required.
Objectives:
The primary objectives of this study were (1) to compare adherence to evidence-based care recommendations using a) electronic health record software, b) paper BedsidePEWS, and c) a novel electronic BedsidePEWS interface, and (2) to describe end-users' experiences of usability and opportunities for improvement of both paper and electronic BedsidePEWS.
Methods:
Paediatric nurses participated in a repeated measures simulation study. Participants assessed simulated patients, documented patient data, and responded to a series of questions regarding follow-up care for each patient. Three patient types (i.e., stable, mild deterioration, severe deterioration) were assessed in each of three intervention conditions (i.e., electronic health record, paper BedsidePEWS, electronic BedsidePEWS). Following simulation scenarios, participants provided comments regarding the usability of the paper and electronic tools.
Results:
Participants made 12.7% and 18.0% more appropriate care decisions with paper and electronic BedsidePEWS, respectively, than with the electronic health record intervention (p < 0.001). Accurate BedsidePEWS severity of illness score calculation was related to better adherence to evidence-based care recommendations (65%), compared to inaccurate calculation (55%), and electronic BedsidePEWS was associated with 15.7% fewer calculation errors than paper (p < 0.005). Electronic BedsidePEWS demonstrated usability benefits over its paper predecessor, including automatic score calculation and data plotting, and the potential to eliminate double charting, and participants expressed a preference for electronic BedsidePEWS in all aspects of the debrief questionnaire (p < 0.001).
Conclusions:
BedsidePEWS in both paper and electronic formats significantly improved participants' ability to detect deterioration and follow care recommendations compared to electronic health record software. Furthermore, results suggest that electronic BedsidePEWS would afford improved patient care in excess of the paper-based original and further contribute to the standardization, prioritization, and improvement of care in community settings.
