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Multicenter Usability Evaluation and Co-Development of a Digital Decision-Support Tool for Labor Triage: Mixed
Mariana Tome1, Xavier Laurent2, Kristiyan Georgiev1
1Nuffield Department of Women's & Reproductive Health, Oxford Labour Monitoring, University of Oxford, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, England, OX3 9DU, United Kingdom, 1 01865 221004.
The Fit4Labour tool, a digital decision-support system for labor care, demonstrated excellent usability and implementation readiness across diverse NHS hospitals. This research aids in developing effective labor triage technologies.
Area of Science:
- Obstetrics and Gynecology
- Clinical Decision Support Systems
- Health Informatics
Background:
- Digital decision-support tools for labor care are limited, struggling with complex, time-sensitive triage decisions.
- Fit4Labour is a research tool combining computerized cardiotocography interpretation with maternal/fetal risk factors for individualized risk scores.
- The tool aims to support clinicians in identifying fetuses needing closer monitoring or expedited delivery, enhancing clinical decision-making.
Purpose of the Study:
- To evaluate the usability and implementation readiness of the digitally co-developed labor decision-support tool (Fit4Labour).
- To assess the tool's performance across NHS hospitals with differing clinical contexts.
Main Methods:
- Convergent parallel mixed methods study in 3 UK hospitals (December 2022 - May 2025).
- Phase 1: Iterative co-development with midwives and doctors at Oxford University Hospitals NHS Foundation Trust.
- Phase 2: Validation at Birmingham Women's and Children's NHS Foundation Trust and Buckinghamshire Healthcare NHS Trust using scenario-based usability sessions (SUS, SEQ), task completion time, focus groups, and interviews.
Main Results:
- Twenty-six healthcare professionals participated in co-development and validation phases.
- The Fit4Labour tool achieved 'excellent' usability thresholds (mean SUS 82.1 during co-development, 85.8 during validation) across all sites.
- High usability scores (SEQ mean 6.1/7) and comparable task completion times were observed; thematic analysis revealed themes in clinical integration, technology adoption, and patient safety.
Conclusions:
- The Fit4Labour tool met usability benchmarks in independent NHS hospitals with different clinical contexts through systematic co-development.
- Clinicians perceived the tool as a supportive aid, enhancing decision-making and risk communication while maintaining clinical autonomy.
- Further prospective evaluation is needed to determine if these usability findings translate to improved clinical outcomes in real-world practice.