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Developing and Testing the Usability of a Novel Child Abuse Clinical Decision Support System: Mixed Methods Study
Amy Thomas1, Andrea Asnes1, Kyle Libby2
1Department of Pediatrics, Yale University School of Medicine, New Haven, CT, United States.
Journal of Medical Internet Research
|March 29, 2024
Summary
A new Child Abuse Clinical Decision Support (CA-CDS) system helps emergency departments identify infant physical abuse. This electronic tool provides evidence-based alerts to improve recognition and evaluation of suspected child abuse cases.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Informatics
- Child Abuse Recognition
Background:
- Child physical abuse is frequently underdiagnosed, particularly in emergency settings.
- Electronic clinical decision support (CDS) systems show promise in enhancing the detection of child abuse.
Purpose of the Study:
- To develop and assess the usability of a natural language processing-based CDS system (CA-CDS) for identifying high-risk injuries suggestive of abuse in infant medical records.
- To refine the CA-CDS system based on clinician feedback.
Main Methods:
- A multidisciplinary team developed the CA-CDS prototype, incorporating user design principles and evidence-based recommendations.
- Usability was evaluated through interviews with 24 clinicians across 4 emergency departments.
- Interview data were analyzed using conventional content analysis to identify themes related to usability, barriers, and facilitators.
Main Results:
- Clinicians identified benefits such as an "extra layer of protection" and evidence-based guidance.
- User-centered design features included soft-stop alerts and integrated documentation.
- Key recommendations for improvement involved content consolidation and clearer design; barriers included alert fatigue and documentation concerns.
Conclusions:
- The CA-CDS system, with its user-centered design and evidence-based content, can assist healthcare providers in real-time recognition and evaluation of infant physical abuse.
- The system has the potential to decrease the incidence of missed child abuse cases.
