Examining Care Planning Efficiency and Clinical Decision Support Adoption in a System Tailoring to Nurses' Graph...

Area of Science:

• Health Informatics
• Nursing Research
• Human-Computer Interaction

Background:

• Electronic health records (EHRs) generate vast health data, increasing the need for effective clinical decision support (CDS).
• CDS format is crucial for accuracy, reducing cognitive load, and documentation burden for healthcare professionals.
• Previous pilot studies highlighted the importance of graph literacy (GL) for registered nurses (RNs).

Purpose of the Study:

• To compare care planning time (CPT) and adoption of evidence-based CDS recommendations among RNs.
• To evaluate four CDS formats: text-only (TO), text+table (TT), text+graph (TG), and a tailored format based on RNs' GL.
• To test the hypothesis that tailored CDS would result in faster CPT and higher adoption rates.

Main Methods:

• A national, web-based randomized controlled trial involving 203 RNs across the United States.
• RNs were randomly assigned to one of the four CDS format groups (TO, TT, TG, tailored).
• Data were analyzed using regression to assess the effect of tailoring and associations between CPT, RN characteristics, and CDS format.

Main Results:

• No significant differences in CPT or CDS adoption rates were found between the tailored and non-tailored CDS groups.
• RNs with low GL experienced longer CPT with TG CDS compared to TO CDS (P=.01).
• CPT in the TG format was associated with RN age, GL, and comfort with EHRs; comfort with EHRs also impacted CPT in the TT format.

Conclusions:

• Tailoring CDS based on RNs' GL did not improve CPT or adoption rates in this study.
• The findings reinforce that low GL is associated with increased CPT when using graphical CDS formats.
• Future research should utilize similar innovative methodologies to explore how RNs' GL and other factors influence efficient CDS development for EHRs.