About the Project
The implementation of health information technology in hospital Emergency Departments (ED) is changing the way healthcare is delivered and is a key component to improving quality of care. However, the beneficial impact of ehealth technology depends highly upon proper design to ensure optimal user adoption, perceived credibility, satisfaction and ease of use. The Scarborough Hospital (TSH) conducted a pilot project to enhance the quality and efficiency of their ED service by implementing two technologies: 1) A kiosk that captures data directly from patients to help clinicians monitor their changing health status, and (2) An electronic triage application that assists nurses in the assignment of patient acuity.
Various human factors methods contributed to the design and evaluation of the patient kiosk and the nurse triaging application. Field observations were conducted in TSH emergency waiting rooms to understand current triaging practices and workflow. Expert evaluations of kiosk and triaging software prototypes were performed to ensure conformance to established usability principles. Patients and nurses participated in low fidelity usability testing to evaluate the ease of use and satisfaction of the kiosk and the triage application. A high fidelity laboratory simulation of the TSH Emergency Department Waiting Room with patient and nurse participants was conducted to examine the effects on workflow. Finally, a post-implementation field study which included questionnaires and shadowing provided an opportunity to discovery how well the high fidelity simulations reflected situations from the actual clinical environment.
The project findings highlighted the importance of conducting usability tests with targeted users to overcome problems related to ease of use, efficiency, and effectiveness. By having actual users try out the product beforehand, the project team was able to streamline the triage application for nurses, address some of the associated issues of patient privacy and information security for patients and collect both nurse and patient perceptions of the new workflow.
The use of human factors methods in this project helped to identify and address problems in user-friendliness, design, and functionality prior to implementation. However, it should also be noted that some additional problems were identified in post-implementation due to differences in the actual implementation from the high-fidelity protocol and implementation plans. This indicates that findings from high fidelity simulation studies are most useful when the recommendations are fully implemented in clinical practice and when there are mechanisms in place to support and sustain the implementation of these technologies.