Ensuring safety and quality of care as well as improving patient and family experiences have been strong drivers for health information technology (HIT) deployment. When designed and implemented well, HIT can revolutionize and improve the way clinicians and families work together. However, currently available HIT applications have made healthcare more fragmented, making it harder to coordinate care among various care team members and families; thus introducing new risks to patient safety. Our long-term goal is to develop innovative and effective concepts and techniques for the next generation of HIT-supported work systems that provide integrated, seamless, safe, and patient and family-centered care based on scientific evidence. Trauma is the leading cause of death and permanent paralysis among the pediatric population. Care transitions of critically ill patients such as trauma patients, to and from the pediatric intensive care unit (PICU) require effective teamwork among the PICU team, other teams and services (e.g., emergency department), as well as the family members. We propose to use a sociotechnical systems approach to the design of HIT that supports pediatric trauma care transitions. We will use the SEIPS 2.0, a sociotechnical systems model for healthcare, complemented by the well-known team processes framework, to ensure that our HIT design supports the cognitive work of the various trauma care team members and families. Nested within the SEIPS 2.0, we will use contextual design methodology, a six-step user-centered design process, to guide our overall design process. Our first specific aim is to describe cognitive teamwork involved in care transitions of pediatric trauma patients. We will focus on three types of care transitions: admission to PICU from emergency department, transfer from PICU to inpatient pediatric general care unit, and hospital discharge directly from PICU. The second specific aim is to develop and test design requirements for future HIT, referred to as the team-centric information technology (TACIT), that supports cognitive teamwork for enhancing safety, quality, and family-centeredness of care. The study will be conducted in three Level I pediatric trauma centers: Johns Hopkins Children's Hospital, UWHealth-American Family Children's Hospital, and the All Children's Hospital. Methods for analyzing cognitive teamwork will be diverse (i.e. contextual inquiry, interviews, focus groups) (Aim 1) and will produce a range of outputs (e.g., process maps, information flow diagrams, artifact analysis, collaboration tables, decision wheels, role network analysis) that wil be used to define the TACIT design requirements (Aim 2). Using a collaborative process among researchers and the various other stakeholders, we will develop preliminary design requirements for the TACIT mock-up and evaluate its usability. This study uses an iterative design approach;
Aim 2 results will help to define additional data collection and analysis needs under Aim 1. When all Aim 1 data have been collected and analyzed, the TACIT design requirements will be finalized (Aim 2).

Public Health Relevance

Ineffective care transitions and handoffs between different units in a hospital can pose significant risks to patient safety, and result in poor clinical and financial outcomes; this is especially true for pediatric trauma care transitions that often take place under high-stress and time-pressure. This application is aimed at developing a deep and broad understanding of the cognitive work of clinician teams and family members involved in pediatric trauma care transitions in order to design usable and useful health information technologies. The results of our research will aid in producing innovative concepts, tools, and methods needed for the next generation of information technology-supported work systems that provide integrated, seamless, safe, and patient and family-centered care.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Project (R01)
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Health Care Technology and Decision Science (HTDS)
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Wyatt, Derrick
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Johns Hopkins University
Internal Medicine/Medicine
Schools of Medicine
United States
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Durojaiye, Ashimiyu B; McGeorge, Nicolette M; Puett, Lisa L et al. (2018) Mapping the Flow of Pediatric Trauma Patients Using Process Mining. Appl Clin Inform 9:654-666
Durojaiye, Ashimiyu B; Puett, Lisa L; Levin, Scott et al. (2018) Linking Electronic Health Record and Trauma Registry Data: Assessing the Value of Probabilistic Linkage. Methods Inf Med :