Hospital acquired conditions (HACs) including catheter-associated urinary tract infection (CAUTI), pressures ulcers, and falls, are common, costly, and largely preventable. As part of a project to develop and visualize patient risk models related to these competing HACs, we designed five low-fidelity visual displays of risk for user-centered design and evaluation by nurses, nurse managers, and physicians who work in acute care settings. Low fidelity visual displays were developed based on literature review of hospital dashboard studies (1-3), the clinical and design expertise by the project team, and two preliminary focus groups (n=6) with nurses and nurse managers at a hospital study site to understand HAC information needs. The low fidelity visual displays presented hypothetical patient data using gauge metaphors, bullseye metaphors, bar graphs, and line graphs of varying colors.
Participants were recruited through investigator contacts at a second hospital study site for user-centered design and evaluation of low fidelity visual displays using focus groups and interviews. Sessions were stratified by participant role. Participant roles by session were: (1) floor nurses, (2) nurse managers, and (3) physicians and physician assistants. After explaining the purpose of the sessions and obtaining informed consent, participants were given hard copies of the five low fidelity prototypes and asked a series of questions regarding their preferences for display elements and interfaces to show HAC information, how visual displays could inform decision-making, and ways a clinical dashboard with visual displays of CAUTI, pressures ulcers, and falls might integrate with clinical information systems and workflows. All sessions were conducted by an informatics design researcher and a second member of the research team as note taker. All sessions were audio-recorded and transcribed verbatim. Two members of the research team will conduct full analysis of transcripts to identify goals, activities, preferred elements of displays, and design recommendations for development of clinical dashboards for multiple competing HACs.
We conducted four user-centered design sessions (n=18 participants) consisting of 3 focus groups and 1 individual interview. Sessions consisted of nurses (n=6, 1 focus group and 1 individual interview), nurse managers (n=8, 1 focus group) and physicians and physician assistants (n=4). Preliminary results indicate strong participant preference for a gauge metaphor to display HAC information and informed design of high fidelity dashboard prototypes for evaluation in three other regional health care systems.
Participant preferences for visual displays are consistent with the clinical dashboard literature. Full analysis will identify themes related to goals, activities, display preferences, and design recommendations for clinical dashboards that support decision-making for CAUTI, pressure ulcers, and falls. Full results in relation to the five low fidelity visual displays will be presented at AMIA 2018 in San Francisco.
This work was supported by AHRQ Contract No. HHSP233201500025I
Dowding D, Randell R, Gardner P, Fitzpatrick G, Dykes P, Favela J, et al. Dashboards for improving patient care: review of the literature. International journal of medical informatics 2015;84(2):87-100
Franklin A, Gantela S, Shifarraw S, Johnson TR, Robinson DJ, King BR, et al. Dashboard visualizations: supporting real-time throughput decision-making. Journal of biomedical informatics 2017;71:211-21.
Wilbanks BA, Langford PA. A review of dashboards for data analytics in nursing. CIN: Computers, Informatics, Nursing 2014;32(11):545-9.

Learning Objective 1: Participants should better understand the use of focus groups and interviews to engage different types of stakeholders in the design and evaluation of low-fidelity prototypes for visual displays of information


Blaine Reeder (Presenter)
University of Colorado College of Nursing

Britney Sutcliffe, University of Colorado College of Nursing
Cynthia Drake, University of Colorado | Anschutz Medical Campus
Mary Beth Flynn Makic, University of Colorado College of Nursing
R Mark Gritz, University of Colorado | Anschutz Medical Campus
Heidi Wald, University of Colorado | Anschutz Medical Campus

Presentation Materials: