User-Centered Design to Reduce Inappropriate Blood Transfusion Orders

Area of Science:

• Healthcare quality improvement
• Human factors engineering
• Clinical informatics

Background:

• Blood transfusion practices require optimization to enhance patient safety and resource utilization.
• User-centered design (UCD) principles can be applied to refine clinical workflows and order entry systems.
• Current blood transfusion order systems may present barriers to optimal guideline adherence.

Purpose of the Study:

• To evaluate clinician preferences for different blood transfusion order designs.
• To identify design elements that improve adherence to transfusion guidelines.
• To enhance the effectiveness of electronic health record (EHR) functionalities for blood ordering.

Main Methods:

• Developed three distinct versions of blood transfusion orders with varied information presentation.
• Engaged 14 clinicians across specialties using a think-aloud technique and qualitative analysis.
• Incorporated clinician feedback and human factors principles into order design modifications.

Main Results:

• The interruptive alert design with behavioral nudges was preferred by 57% (8/14) of clinicians.
• Clinicians found interruptive alerts more effective in capturing attention and prompting guideline consideration compared to in-line alerts.
• All participants supported general improvements, indicating a positive reception to user-informed design changes.

Conclusions:

• Clinician input through UCD is crucial for designing effective clinical tools.
• Interruptive alerts, when thoughtfully integrated, can improve workflow and guideline adherence in blood transfusion ordering.
• Further trials are warranted to validate the impact of optimized transfusion order designs on clinical practice.