TY - JOUR
T1 - Neonatal Intensive Care Workflow Analysis Informing NEC-Zero Clinical Decision Support Design
AU - Gephart, Sheila M.
AU - Tolentino, D. Anthony
AU - Quinn, Megan C.
AU - Wyles, Christina
N1 - Funding Information:
This project was funded by the Agency for Healthcare Research and Quality (AHRQ) (K08HS022908). The content is solely the responsibility of the authors and does not necessarily represent the official views of AHRQ. D.A.T. declares funding support from the University of Michigan School of Nursing and the National Clinician Scholars Program at the Institute for Healthcare Policy and Innovation at the University of Michigan. GutCheck and NEC-Zero are the intellectual property of S.M.G. and the University of Arizona. S.M.G. has received modest honoraria for presentations sponsored by Prolacta Bioscience, Mead Johnson, and Abbott Nutrition. For the remaining authors, no competing financial interests are declared. NEC
Publisher Copyright:
© Lippincott Williams & Wilkins.
PY - 2023/2/23
Y1 - 2023/2/23
N2 - Decision support in neonatal ICUs is needed, especially for prevention and risk awareness of the devastating complication of necrotizing enterocolitis, a major cause of emergency surgery among fragile infants. The purpose of this study was to describe the current clinical workflow and sociotechnical processes among clinicians for necrotizing enterocolitis risk awareness, timely recognition of symptoms, and treatment to inform decision support design. A qualitative descriptive study was conducted. Focus groups were held in two neonatal ICUs (five groups in Unit A and six in Unit B). Transcripts were analyzed using content analysis and compared with field notes. Clinicians (N = 27) included nurses (37%), physicians (30%), neonatal nurse practitioners (19%), and other staff (16%). Workflow processes differed for nurses (who see necrotizing enterocolitis signs and notify providers to order diagnostic tests and treatments) and providers (who receive notification of necrotizing enterocolitis concern and then decide how to act). Clinicians desired (1) a necrotizing enterocolitis-relevant dashboard to support nutrition tracking and necrotizing enterocolitis recognition; (2) features to support decision-making (eg, necrotizing enterocolitis risk and adherence scoring); (3) breast milk tracking and feeding clinical decision support; (4) tools for necrotizing enterocolitis surveillance and quality reporting; and (5) general EHR optimizations to improve user experience.
AB - Decision support in neonatal ICUs is needed, especially for prevention and risk awareness of the devastating complication of necrotizing enterocolitis, a major cause of emergency surgery among fragile infants. The purpose of this study was to describe the current clinical workflow and sociotechnical processes among clinicians for necrotizing enterocolitis risk awareness, timely recognition of symptoms, and treatment to inform decision support design. A qualitative descriptive study was conducted. Focus groups were held in two neonatal ICUs (five groups in Unit A and six in Unit B). Transcripts were analyzed using content analysis and compared with field notes. Clinicians (N = 27) included nurses (37%), physicians (30%), neonatal nurse practitioners (19%), and other staff (16%). Workflow processes differed for nurses (who see necrotizing enterocolitis signs and notify providers to order diagnostic tests and treatments) and providers (who receive notification of necrotizing enterocolitis concern and then decide how to act). Clinicians desired (1) a necrotizing enterocolitis-relevant dashboard to support nutrition tracking and necrotizing enterocolitis recognition; (2) features to support decision-making (eg, necrotizing enterocolitis risk and adherence scoring); (3) breast milk tracking and feeding clinical decision support; (4) tools for necrotizing enterocolitis surveillance and quality reporting; and (5) general EHR optimizations to improve user experience.
KW - Clinical decision support
KW - NEC-Zero
KW - Necrotizing enterocolitis
KW - Neonatal intensive care
KW - Workflow mapping
UR - http://www.scopus.com/inward/record.url?scp=85147457879&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85147457879&partnerID=8YFLogxK
U2 - 10.1097/CIN.0000000000000929
DO - 10.1097/CIN.0000000000000929
M3 - Article
C2 - 35470306
AN - SCOPUS:85147457879
SN - 1538-2931
VL - 41
SP - 94
EP - 101
JO - CIN - Computers Informatics Nursing
JF - CIN - Computers Informatics Nursing
IS - 2
ER -