Abstract
BackgroundEmergency departments (EDs) frequently care for individuals with opioid use disorder (OUD). Buprenorphine (BUP) is an effective treatment option for patients with OUD that can safely be initiated in the ED. At present, BUP is rarely initiated as a part of routine ED care. Clinical decision support (CDS) could accelerate adoption of ED-initiated BUP into routine emergency care.ObjectiveThis study aimed to design and formatively evaluate a user-centered decision support tool for ED initiation of BUP for patients with OUD.MethodsUser-centered design with iterative prototype development was used. Initial observations and interviews identified workflows and information needs. The design team and key stakeholders reviewed prototype designs to ensure accuracy. A total of 5 prototypes were evaluated and iteratively refined based on input from 26 attending and resident physicians.ResultsEarly feedback identified concerns with the initial CDS design: an alert with several screens. The timing of the alert led to quick dismissal without using the tool. User feedback on subsequent iterations informed the development of a flexible tool to support clinicians with varied levels of experience with the intervention by providing both one-click options for direct activation of care pathways and user-activated support for critical decision points. The final design resolved challenging navigation issues through targeted placement, color, and design of the decision support modules and care pathways. In final testing, users expressed that the tool could be easily learned without training and was reasonable for use during routine emergency care.ConclusionsA user-centered design process helped designers to better understand users’ needs for a Web-based clinical decision tool to support ED initiation of BUP for OUD. The process identified varying needs across user experience and familiarity with the protocol, leading to a flexible design supporting both direct care pathways and user-initiated decision support.
Highlights
BackgroundOpioid use disorder (OUD) is an escalating public health crisis that has impacted all regions of the United States and represents a substantial portion of emergency department (ED) visits each year
User feedback on subsequent iterations informed the development of a flexible tool to support clinicians with varied levels of experience with the intervention by providing both one-click options for direct activation of care pathways and user-activated support for critical decision points
The initial design was an Epic (Epic Systems, Verona, WI) best practice alert (BPA; Figure 1) triggering a pop-up window when a patient was identified as potentially having opioid use disorder (OUD)
Summary
Opioid use disorder (OUD) is an escalating public health crisis that has impacted all regions of the United States and represents a substantial portion of emergency department (ED) visits each year. ED-initiated BUP has not yet been adopted in most hospitals [9,10] This delay in adoption of evidence-based practice is not unique—on average, it takes 17 years from discovery to the adoption of evidence-based practices into routine care [11,12]. Emergency departments (EDs) frequently care for individuals with opioid use disorder (OUD). Buprenorphine (BUP) is an effective treatment option for patients with OUD that can safely be initiated in the ED. Clinical decision support (CDS) could accelerate adoption of ED-initiated BUP into routine emergency care
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