Applying a human factors approach to improve usability of a decision support system in tele-nursing

Abstract

Summary Aim To evaluate usability of a decision support system for telephone triage nurses. Background Telephone triage by nurses has become an internationally accepted form of health service delivery to cope with increasing demands on primary and emergency care. Decision support software systems are used by nurses to facilitate the telephone triage process, yet, the usability of these systems is rarely assessed. Method We applied a multi-method human factors approach to evaluate the usability of decision support software used by Healthdirect Australia nurses during telephone triage. Methods included: (1) stakeholder discussions; (2) heurstic analysis by two independent experts across ten usability heuristics; and (3) interviews with system end users ( n =9). A list of heuristic violations with their severity ratings was developed. Qualitative content analysis of the interview transcripts was undertaken to validate the results of the heuristic evaluation. Findings Forty one unique heuristic violations were identified in the interface design of the decision support software with median severity of 2.25 (range 0–4, with 0=no problem to 4=catastrophic problem). The highest number of violations was observed for flexibility and efficiency of use ( n =12, median severity=2.5) and for aesthetic and minimalist design ( n =11, median severity=2). Interviews with nurses verified many of the violations identified in the heuristic analysis. Improving the navigational design of the system for flexibility and efficiency of use was identified as necessary by both the experts and end users. Conclusion In adopting a multi-method human factors approach, we identified a number of system design features which may be impacting on the safety and efficiency of the nurse telephone triage process. Addressing the identified usability issues and using feedback from end-users to modify the decision support system would optimise system use and so improve the triage process.