Overcoming User-Centered Challenges with Complex Health Technology

Challenges and Burdens in the Coronary Artery Disease Care Pathway for Patients Undergoing Percutaneous Coronary Intervention: A Contemporary Narrative Review

Clinical and economic burdens exist within the coronary artery disease (CAD) care pathway despite advances in diagnosis and treatment and the increasing utilization of percutaneous coronary intervention (PCI). However, research presenting a comprehensive assessment of the challenges across this pathway is scarce. This contemporary review identifies relevant studies related to inefficiencies in the diagnosis, treatment, and management of CAD, including clinician, patient, and economic burdens. Studies demonstrating the benefits of integration and automation within the catheterization laboratory and across the CAD care pathway were also included. Most studies were published in the last 5-10 years and focused on North America and Europe. The review demonstrated multiple potentially avoidable inefficiencies, with a focus on access, appropriate use, conduct, and follow-up related to PCI. Inefficiencies included misdiagnosis, delays in emergency care, suboptimal testing, longer procedure times, risk of recurrent cardiac events, incomplete treatment, and challenges accessing and adhering to post-acute care. Across the CAD pathway, this review revealed that high clinician burnout, complex technologies, radiation, and contrast media exposure, amongst others, negatively impact workflow and patient care. Potential solutions include greater integration and interoperability between technologies and systems, improved standardization, and increased automation to reduce burdens in CAD and improve patient outcomes.

Complex Medical Technology: Strategies for Selection, Education and Competency Assessment, and Adoption

The prevalence of complex technology in the health care arena has increased dramatically in the 21st century. Nurses working in acute and critical care have the greatest interaction with technology, using it to manage patients and optimize clinical outcomes as well as to prevent errors and adverse events. The successful implementation of complex medical technology is, in itself, a complex process. The purpose of this article is to provide nurse leaders and clinical nurses with an overview of key steps in product selection, associated risk assessment, and establishing a business case for technology. We review an educational and competency assessment framework based on adult learning principles and discuss strategies for successful technology adoption. An example of evaluation of a program using the New World Kirkpatrick Model is included, along with a tool for clinicians to use that summarizes the selection and implementation process.