Assistant Professor Childrens Hospital of Philadelphia Philadelphia, Pennsylvania, United States
Background: Accurate and timely documentation of events and interventions is critical to guide delivery room (DR) resuscitative steps as well as post-resuscitation care. Documentation can carry significant cognitive load, given multiple streams of information that need to be entered in addition to accomplishing other assigned tasks. Recently electronic health records have incorporated modules, frequently called narrators, to help decrease cognitive load, task burden, and improve accuracy of documentation. Evaluation of usability prior to technology implementation can ameliorate challenges that would interfere with accuracy and efficiency. Objective: To investigate the usability of a newborn resuscitation code narrator prior to implementation. Design/Methods: An initial newborn resuscitation code narrator was developed for DR resuscitations in the electronic health record. Usability testing was performed prior to implementation in clinical practice through administration of the usability metric for user experience (UMUX, Figure 1) survey. 12 nurses (Table 1) participated in the initial usability testing (Phase 1), which consisted of the UMUX as well as iterative usability testing, where participants were encouraged to “think out loud” and provide insight about code narrator. Feedback received was incorporated into code narrator revisions before the next session.
The second usability testing (Phase 2) consisted of collecting UMUX after nurses received hands-on code narrator training using video recorded resuscitations (Table 1). Results: User feedback from the iterative usability testing combined respiratory and vent settings under a same screen, with a UMUX score of 71% (standard deviation [SD] 8%). Users voiced concerns of a steep learning curve but agreed the system implementation would help with documentation. The UMUX score was 69% (SD 15%), for the second phase. There was no significant difference between the two phases, though users believed usability will improve with practice.
Conclusion(s): Usability testing is important when developing and implementing new technology. The iterative feedback and UMUX data obtained in this study led to important changes to the code narrator. Lack of familiarity with code narrator may explain the lack of UMUX score change between phases. The UMUX data will serve as a baseline to be compared with UMUX data collected post clinical implementation of code narrator. This will help to assess the learning curve and provide feedback for additional changes that may improve usability.
