User-centred design of bedside clinical guidelines for mobile devices

Abstract

Local point of care clinical guidelines exist in numerous formats and cover a variety of clinical information, normally created on a national and local level. They are generally available as basic web pages, PDFs or documents. Despite widespread availability and use, accessing clinical guidelines and information can be highly inefficient and restrictive. The adoption of technology in health and care is increasing. Despite this increased uptake, some areas of clinical practice are still required to access and utilise clinical information that is inefficient or restrictive. Therefore, mobile device information delivery is becoming a key factor in providing health and care information at the bedside. However, recommendations on how to present clinical information on mobile devices (such as clinical guidelines with calculation/decision tools) are limited or not optimised for modern mobile design.

This study investigates the design, adaption and delivery of a clinical guidelines mobile application in the challenging area of co-design with clinicians with the aim of developing recommendations to assist in creating and delivering clinical guidelines on mobile devices. It also aims to answer if the selected methods of user-centred design are suitable when working with limited access to users and what design recommendations can be elicited/changed by utilising user-centred design (UCD) methods to gather feedback on features and functions. This study utilises a set of ‘Bedside clinical guidelines’ that have been utilised in numerous NHS Trusts in the UK for over twenty years.

Utilising results from user-centred design studies such as observations, surveys, focus groups and think-aloud, and analysing results from system usability scale (SUS), this thesis presents recommendations to assist in creating and delivering bedside clinical guidelines on mobile devices. A set of 15 recommendations elicited from qualitative and quantitative user-centred design studies are presented along with insights into clinical technology use and the comparisons of user behaviour in terms of knowledge and clinical workflow. It also discusses clinical technology in terms of app use and device requirements. This work also presents novel methods of displaying decision algorithms and discusses the necessity of delivering clinical warnings with methods that do not contribute to alert fatigue. Other findings such as methods of reducing clinical guideline sentences for easier information assimilation and replacing manual methods of calculation are also discussed. Importantly, this work introduces novel methods of user-centred design that enable feedback elicitation from time-constrained and dominant subject groups, this was important in terms of working with clinicians to co-design a mobile application. It evidences the impact of working with a clinical expert and the outcomes such work can produce.

These studies found that clinicians use a mixture of technology to retrieve information, which is often inefficient or has poor usability. It also shows that smartphone application development for use in UK hospitals needs to consider the variety of users and their clinical knowledge and work pattern. This study highlights the need for applying user-centred design methods in the design of information presented to clinicians and the need for clinical information delivery that is efficient and easy to use at the bedside. It also highlights the need to adapt user-centred design methods to enable the elicitation of information from time-constrained groups and the importance of working with a clinical expert. The studies presented have culminated in the delivery of 154 clinical guidelines, co-designed with clinicians, and a framework for the delivery of over one thousand further guidelines. It is the first study to investigate the mobile delivery of bedside clinical guidelines utilising usercentred design methodologies.