A human factors approach to observation chart design can trump health professionals’ prior chart experience

• Published in: Resuscitation Vol. 84; no. 5; pp. 657 - 665
• Main Authors: Christofidis, Melany J, Hill, Andrew, Horswill, Mark S, Watson, Marcus O
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01.05.2013
• Subjects: Adult; Australia; Clinical Competence; Clinical experience; Design; Emergency; Female; Health Personnel - standards; Human factors; Humans; Male; Medical Errors - statistics & numerical data; Medical Records - standards; Medical Records - statistics & numerical data; Middle Aged; Observation chart; Patient deterioration; Australia; Design; Patient deterioration; Observation chart; Clinical experience; Human factors
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2012.09.023

Abstract Aim To determine whether experienced health professionals recognise patient deterioration more accurately and efficiently using (a) novel observation charts, designed from a human factors perspective, or (b) chart designs with which they have long-term experience. Methods Participants were 101 health professionals experienced in using either a multiple parameter track-and-trigger chart or a graphical chart with no track-and-trigger system. Participants were presented with realistic abnormal and normal patient observations recorded on six hospital observation charts of varying design quality, including the chart that participants were familiar with (or a very similar design). Across 48 trials, the participant was asked to specify if any of the vital sign observations were abnormal, or if all of the observations were normal. Participants’ overall error rates (i.e., proportion of incorrect responses) and response times, the main outcome measures, were calculated for each observation chart. Results Participants made significantly fewer errors and responded significantly faster when using a novel user-friendly chart compared with all the other designs, including the charts that they were experienced with in a clinical setting. Conclusions The findings suggest that, at least in the contexts examined, superior observation chart design appears to trump familiarity. Hence, hospitals motivated to improve the detection of patient deterioration should implement charts designed from a human factors perspective, rather than simply maintaining the status quo of reliance on clinical experience.