Neonatal Intensive Care Workflow Analysis Informing NEC-Zero Clinical Decision Support Design

Area of Science:

• Neonatal Medicine
• Clinical Informatics
• Healthcare Systems Engineering

Background:

• Necrotizing enterocolitis (NEC) is a severe gastrointestinal complication in premature infants, necessitating improved prevention and management strategies.
• Current clinical workflows for NEC awareness, recognition, and treatment in neonatal intensive care units (NICUs) lack integrated decision support.
• Sociotechnical processes influence the timely identification and management of NEC, impacting patient outcomes.

Purpose of the Study:

• To describe current clinical workflows and sociotechnical processes for NEC risk awareness, symptom recognition, and treatment in NICUs.
• To identify clinician needs for decision support tools to enhance NEC management.
• To inform the design of effective decision support systems for NEC prevention and care.

Main Methods:

• A qualitative descriptive study utilizing focus groups with NICU clinicians.
• Content analysis of focus group transcripts and field notes from two NICUs.
• Inclusion of diverse clinical roles: nurses, physicians, and neonatal nurse practitioners.

Main Results:

• Significant differences exist in workflow processes between nurses and providers regarding NEC notification and decision-making.
• Clinicians expressed a strong desire for an NEC-specific dashboard for nutrition tracking and recognition.
• Key desired features include risk/adherence scoring, breast milk/feeding support, surveillance tools, and EHR optimizations.

Conclusions:

• Enhanced decision support is crucial for improving NEC prevention and management in NICUs.
• Clinician-identified needs highlight specific areas for technological intervention, such as integrated dashboards and improved EHR functionality.
• Addressing sociotechnical aspects and optimizing user experience are vital for successful implementation of new support tools.