Background: Fever in infants < 90 days old can indicate a serious bacterial infection (SBI) such as urinary tract infection, bacteremia, or meningitis. Clinical management of febrile infants varies widely. Implementing clinical practice guidelines (CPGs) can help standardize care, and electronic clinical decision support (eCDS) tools are a potential means of distributing CPGs. Little is known regarding the individual-level impact of eCDS tool use on medical decision-making. Childrens Mercy Kansas City developed a mobile eCDS tool (CMPeDS: Pediatric Decision Support) that was used internationally in a practice standardization project focused on the management of febrile infants.
Methods: We conducted a prospective cross-over simulation study amongst pediatric healthcare providers. Attending and resident physicians performed simulated patient scenarios using either CMPeDS or a standard text reference (the Harriet Lane Handbook). Participants responses in the simulation were evaluated based on adherence to evidence-based guidelines. Participants mental workload was assessed using the NASA Task Load Index survey (NASA-TLX, in which lower scores are optimal) to assesses mental, physical, and temporal demand, as well as performance, effort, and frustration when completing a series of tasks. Paired t-test and ANOVA were used to determine significance for case performance scores and NASA-TLX scores respectively. A System Usability Scale (SUS) was used to determine usability of the CMPeDS app.
Results: A total 28 of 32 planned participants have completed trial procedures to date. Mean performance scores on the cases were significantly higher with CMPeDS vs. standard reference, (87.7% versus 72.4% [t(27) 3.22, p 0.003]). Participants reported lower scores on the NASA-TLX when using CMPeDS compared to standard reference tool (Figure 1). Mean score on SUS was 88.2 (scale 0-100) indicating excellent tool usability (Figure 2).
Conclusion: Using the eCDS tool CMPeDS was associated with significantly increased adherence to evidence-based guidelines for febrile infant management and decreased mental workload in simulation. Our findings highlight the potential value of eCDS deployment as part of CPG implementation projects.
E. Kerns, None
R. Mcculloh, None