An online tool for investigating clinical decision making

A scoping review of medical practice variation research within the informatics literature

RATIONALE

We performed a scoping review of informatics core literature about medical practice variation (MPV) as an agile summary of the subject in our field.

MATERIALS AND METHODS

The Ovid integrated database was searched between 1946 and 2022 to identify MPV studies published in major informatics journals and conference proceedings. Two reviewers performed relevance screening, with assistance from another independent reviewer for adjudication. The included articles were then thematically analyzed and summarized through discussion among all three reviewers.

RESULTS

A total of 43 articles were included and went through the thematic analysis. About half (n = 21) of the included articles were published in conference proceedings. Five articles reported the effect of MPV on patient outcomes. The variation of interest was most frequently in treatment decisions. In terms of the role informatics played (multiple roles allowed), 39 (90.7%) articles pertained to detection of MPV, 5 were about prevention of MPV and 4 about learning from MPV.

DISCUSSION

MPV remains a critical issue in health care, yet most informatics research has been focused on simple tasks such as automating the detection of MPV and assessing compliance to decision-support systems, and less focused on addressing the causes of variation or supporting learning from variation.

CONCLUSION

Our scoping review found that informatics studies have focused on detecting of MPV, especially variability in treatments and deviation from practice guidelines. Technological advances should promote more informatics research focused on explaining and learning from MPV.

Development and preliminary testing of an online software system to facilitate assessment of accuracy and consistency in applying the Australasian Triage Scale

PURPOSE

The aim of this project was to design and evaluate an online software system to facilitate the assessment of triage decision accuracy and consistency in applying the Australasian Triage Scale.

BACKGROUND

Triage is a critical component of emergency nursing practice, which affects patient access to emergency care. Accurate and consistent triage decisions are vital to ensuring patient safety, timely access to care and ED operation. Presently, there is no standard process to examine triage decisions, measure current performance and support department and individual performance development activities to improve patient safety and quality of emergency care.

METHOD

An iterative design guided by a human factors development approach was used to develop a retrospective, focus-based analysis system to evaluate triage decision accuracy and consistency, and enable the exploration of service gaps and opportunities for practice change and professional development.

RESULTS

Triage decision accuracy and consistency, including areas for improvement are detectable and quantifiable. Findings generated may aid in departmental performance and professional development of triage nurses.

CONCLUSION

This is the first system developed to assess decision accuracy and consistency in applying the Australasian Triage Scale. This paper has described the development and preliminary testing of a user-centred design process and implementation of a web-based system to evaluate triage decision accuracy and consistency.