314 - From Display to Decision: Redesigning a PICU In-Room Dashboard to Optimize Clinical Decision Support

Publication Number: 1298.314

Andrew Furthmiller, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Andrea Meisman, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Matthew Molloy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Daniel Loeb, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Matthew Zackoff, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Maya Dewan, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Background: Patient data dashboards have emerged as an important form of clinical decision support in intensive care settings. The pediatric intensive care unit (PICU) at a large quaternary pediatric academic medical center utilizes an in-room patient data dashboard, Epic Monitor, to display clinical data and care team information, yet staff utilization of this dashboard has remained low.

Objective: To identify the workflow and information needs of PICU bedside staff and physicians to inform a user-centered redesign of the Epic Monitor while maintaining utility for caregivers.

Design/Methods: A mixed-methods needs assessment was conducted in a 48-bed PICU to evaluate usage, usability, and utility of the current Epic Monitor. Staff and caregivers were invited to complete surveys adapted from the Unified Theory of Acceptance and Use of Technology (UTAUT) framework to enable comparative assessment of usefulness, usability, and acceptance of a future redesigned Epic Monitor. Semi-structured interviews employing user experience (UX) methods of wireframing and card sorting were conducted with staff until saturation was achieved to guide a redesigned Monitor prototype.

Results: A total of 87 PICU staff (60 nurses, 11 APRNs, 7 fellows, 9 attendings) and 24 caregivers completed the survey over a one-month voluntary enrollment period. Eight additional staff completed semi-structured interviews. Staff reported low utilization (81% used ≤2 times per shift). UTAUT scores were similar between healthcare professionals (MD, DO, APRN) and nurses (Figure 1). Notably, fewer than 20% of staff agreed the Epic Monitor provided relevant information for rapid patient assessment or medical intervention (Table 1). Usage barriers highlighted in interviews included (1) the required keyboard to navigate between three dashboard views (74% never switched to patient data views), (2) redundant or irrelevant patient information, and (3) lack of user education. Caregivers universally valued the list of care team names. UX methods generated a wireframe of the redesigned Epic Monitor (Figure 2), including (1) a single unified view, (2) emphasis on vital sign and infusion data visualization, (3) a six-hour lookback window, (4) a streamlined patient calendar, and (5) team member photos.

Conclusion(s): Low utilization of the current Epic Monitor reflects workflow misalignment and poor usability. The user-centered redesign produced a single-view dashboard design emphasizing actionable clinical data, as identified by staff, to support real-time decision-making while improving usability and reducing complexity.

Figure 1: UTAUT Mean Likert Score by Role
UTAUT Graph.pdfUnified Theory of Acceptance and Use of Technology (UTAUT) results by role. Mean (±SD) Likert-scale scores for Performance Expectancy, Effort Expectancy, and Facilitating Conditions domains, stratified by role (RN vs. MD/DO/APRN).

Table 1: Unified Theory of Acceptance and Use of Technology (UTAUT) Results
UTAUT Table.pdfUnified Theory of Acceptance and Use of Technology (UTAUT) results by role. Percentage of respondents who selected “Agree” (4) or “Strongly Agree” (5) for each UTAUT question on a 5-point Likert-scale.

Figure 2: Epic Monitor Unified Display Wireframe
Wireframe Epic Monitor.pdfEpic Monitor Unified Display Wireframe. Single-screen layout consolidating vital signs and infusion rate trends, pertinent medications, fluid balance, care team information and photos while retaining imaging and laboratory result links.