ED nurses need their own say on usability – Mar 2021

ED physicians recently gave a thumbs down on fifteen of the Electronic Patient Record systems used in their NHS Emergency Departments.

 

@RColEM naturally surveyed its members and fellows so only doctors gave their opinions. None of the systems in UK EDs met international standards of acceptable usability [1].

 

We fear that these EPR systems are designed with little thought for the nurses who also have to use them. Nurses we surveyed in 2016 had low opinions of the software they had used [2]. So we embarked on designing software specifically for, and with, ED nurses.

 

ED managers are focused on the data they want to gather, not how that is achieved. Speed, accuracy and completeness of data entry all need careful design. Since ED patients undergo a serial process [2 & Feb Blog]: triage, then investigation, then treatment, results from each step need to be readily and speedily displayed to the next member of ED staff who sees each patient. The ‘clutter’ on EPR screens may mean ‘its all there’ and satisfy managers or CIOs, but make it extremely difficult to spot an important item. We have made strenuous efforts to resist clutter and other bad habits and design our app with the stressful ED environment specifically in mind.

 

As Bloom et al [1] point out, poor usability is not only a safety issue for patients, but also a potential contributor to staff burn out and high staff turnover. Sadly the latter means that none of the nurses who used our first SortED prototype in 2017 is available for our latest (and hopefully final) clinical trial before product launch. The training burden is also excessive with most EPRs. Our own training program for the present trial has currently been delayed by covid but hopefully nurses will find the current version as easy to learn and use as the first.

 

The sheer size and complexity of most EPR systems means that vendors are slow to put in adaptations for quality improvement. Agile development of apps for specific nurse-led and patient-facing tasks such as initial assessment may provide an answer both to improve some facets of usability and to test and rapidly implement quality improvements. We believe that replacing triage with nurse-led RAT where investigations and treatments are ordered earlier in the patients’ journey needs a new ‘Front door’ app. Capturing more data and doing more for the patient than conventional #triage is long overdue.

 

Thanks to the Imperial Health Charity we will soon be surveying nurses’ opinion the latest release of our RAT decision support tool for nurses. We will also have feedback on how quickly nurses learn to use the app.

 

[1] Bloom BM, et al. Usability of electronic health record systems in UK EDs. Emerg Med J. 2021 Mar 3:emermed-2020-210401. doi: 10.1136/emermed-2020-210401.
[2] Cleaver B et al. Evaluation of a new rapid assessment and treatment (RAT) tablet app for Emergency Department (ED) nurses: Is earlier identification of investigations and treatments feasible? Int Emerg Nurs. 2020 May 15:100875. doi: 10.1016/j.ienj.2020.100875.

 

Gillie Francis – Mar 2021