JMIR Publications

ABSTRACT

Background:

Substantial unwarranted variations exist in laboratory test ordering practices in the Emergency Department (ED). Drivers for such variation are many and varied, and deeply ingrained within organisational culture and work practices. An appreciation of the impact of contextual factors on digital health implementation is essential to achieve intended outcomes.

Objective:

This study aimed to develop and evaluate the ED Electronic Laboratory Test Ordering Decision Support Tool (ED-POST) through co-design and collaboration with key stakeholders.

Methods:

A multi-method qualitative co-design approach was adopted to ensure that the final tool was suitable for the clinical context. Interviews and observations were conducted to understand existing laboratory test ordering workflows. A prototype of the tool was developed and demonstrated to clinicians, and feedback was triangulated at a stakeholder forum with representatives from additional sites.

Results:

The perceived use and value of ED-POST varied depending on user role. Triage nurses who ordered preliminary tests at the beginning of the patient encounter were more likely to use ED-POST for point-of-ordering decision making. Junior physicians saw value in ED-POST as a form of backup to reaffirm personal impressions. Senior physicians responsible for determining a differential diagnosis at a later stage of the patient journey saw less utility in ED-POST for supporting ordering decisions, but potential in its big data synthesis capabilities to support reporting and quality improvement.

Conclusions:

Understanding roles and workflows in the early developmental stages of a digital health tool and user involvement at every stage are necessary to optimise adoption, scalability and outcomes.