Understanding Workflow Nuances That Affect the Use of a Laboratory Test Ordering Support Tool

Area of Science:

• Health Informatics
• Clinical Pathology
• Emergency Medicine

Background:

• Electronic laboratory test ordering decision support tools aim to standardize practices.
• The Emergency Department Pathology Order Support Tool (ED-POST) was developed to reduce variability in test ordering.
• Understanding real-world clinical workflows is crucial for the successful implementation of digital health tools.

Purpose of the Study:

• To explore workflow nuances impacting the use of the ED-POST tool.
• To identify contextual factors influencing the adoption and utility of digital decision support in the ED.

Main Methods:

• Semi-structured, in-depth interviews were conducted with 15 Emergency Department (ED) clinicians.
• Participants were involved in the co-design, development, and evaluation phases of ED-POST.
• Qualitative data analysis focused on identifying workflow characteristics relevant to the tool's use.

Main Results:

• Clinicians highlighted the increasing role of registered nurses in ordering pathology tests.
• The practice of ordering tests outside the ED's defined scope was identified as a significant factor.
• These workflow elements can affect the perceived utility and actual use of the ED-POST tool.

Conclusions:

• Bridging the gap between planned (work-as-imagined) and actual (work-as-done) clinical practice is essential for electronic intervention success.
• Designing digital tools like ED-POST requires a deep understanding of dynamic clinical workflows.
• Effective implementation of pathology order support tools necessitates adaptation to the realities of clinical practice.