BACKGROUND The Bedside Paediatric Early Warning System (BedsidePEWS) is a clinical decision support tool designed to augment clinician expertise, objectively identify children at risk for clinical deterioration, and standardize and prioritize care to improve outcomes in community settings. Although the paper-based BedsidePEWS documentation record has been shown to improve clinicians' perception of their ability to detect deterioration and follow care recommendations, research is needed to asses this impact empirically. Furthermore, as hospitals progressively move toward electronic clinical systems, knowledge regarding the impact of BedsidePEWS' novel electronic interface on clinicians' performance and user experience is required. OBJECTIVES The primary objectives of this study were (1) to compare adherence to evidence-based care recommendations using a) electronic health record software, b) paper BedsidePEWS, and c) a novel electronic BedsidePEWS interface, and (2) to describe end-users' experiences of usability and opportunities for improvement of both paper and electronic BedsidePEWS. METHODS Paediatric nurses participated in a repeated measures simulation study. Participants assessed simulated patients, documented patient data, and responded to a series of questions regarding follow-up care for each patient. Three patient types (i.e., stable, mild deterioration, severe deterioration) were assessed in each of three intervention conditions (i.e., electronic health record, paper BedsidePEWS, electronic BedsidePEWS). Following simulation scenarios, participants provided comments regarding the usability of the paper and electronic tools. RESULTS Participants made 12.7% and 18.0% more appropriate care decisions with paper and electronic BedsidePEWS, respectively, than with the electronic health record intervention (p < 0.001). Accurate BedsidePEWS severity of illness score calculation was related to better adherence to evidence-based care recommendations (65%), compared to inaccurate calculation (55%), and electronic BedsidePEWS was associated with 15.7% fewer calculation errors than paper (p < 0.005). Electronic BedsidePEWS demonstrated usability benefits over its paper predecessor, including automatic score calculation and data plotting, and the potential to eliminate double charting, and participants expressed a preference for electronic BedsidePEWS in all aspects of the debrief questionnaire (p < 0.001). CONCLUSIONS BedsidePEWS in both paper and electronic formats significantly improved participants' ability to detect deterioration and follow care recommendations compared to electronic health record software. Furthermore, results suggest that electronic BedsidePEWS would afford improved patient care in excess of the paper-based original and further contribute to the standardization, prioritization, and improvement of care in community settings.

中文翻译：

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评估电子床边儿科预警系统：关于决策和可用性的模拟研究。

背景技术床边儿科早期预警系统（BedsidePEWS）是一种临床决策支持工具，旨在增强临床医生的专业知识，客观地确定有临床恶化风险的儿童，并规范护理工作并对其进行优先排序以改善社区环境的结果。尽管纸质BedsidePEWS文档记录已显示出可改善临床医生对他们发现恶化和遵循护理建议的能力的感知，但仍需要进行研究以凭经验评估这种影响。此外，随着医院逐渐走向电子临床系统，需要有关BedsidePEWS新颖的电子界面对临床医生的性能和用户体验的影响的知识。目的本研究的主要目的是（1）使用a）电子健康记录软件，b）纸质BedsidePEWS和c）新型电子BedsidePEWS接口比较依循循证护理建议的情况，以及（2）描述最终的-用户对纸质和电子BedsidePEWS的可用性和改进机会的体验。方法儿科护士参加了一项重复措施模拟研究。参与者评估了模拟患者，记录了患者数据，并回答了有关每个患者后续护理的一系列问题。在三种干预条件（即电子健康记录，纸质BedsidePEWS，电子BedsidePEWS）中，分别评估了三种患者类型（即稳定，轻度恶化，严重恶化）。在模拟情况下，参与者提供了有关纸张和电子工具可用性的评论。结果与电子病历干预相比，与纸质和电子病历干预相比，与纸质和电子BedsidePEWS相比，参与者做出的适当护理决定分别多了12.7％和18.0％（p <0.001）。与不准确的计算（55％）相比，准确的BedsidePEWS疾病评分计算的严重性与更好地遵守循证护理建议（65％）有关，而电子BedsidePEWS的计算错误比纸张计算少15.7％（p <0.005） 。电子BedsidePEWS展示了其纸质前辈产品在可用性方面的优势，包括自动得分计算和数据绘图以及消除重复图表的潜力，参与者在汇报调查表的各个方面都表示偏好使用电子BedsidePEWS（p <0.001）。结论与电子病历软件相比，纸质和电子格式的BedsidePEWS显着提高了参与者发现病情恶化和遵循护理建议的能力。此外，研究结果表明，电子BedsidePEWS可以提供​​比纸质原版纸更好的患者护理，并进一步促进社区环境中护理的标准化，优先次序和改善。