Table 2.

Design element considerations for PB-CDS tools

Elements	Participant preferences	Expert evaluation
Trends	Desire current value in addition to historical trends Want to know when previous values were acquired Trends should be linear (not circular) Moving 12 h window	Consider combinations of color-coding and ranking
Layers and Filters	Ability to select which variables to include Vital sign values most preferred (laboratory values mentioned far less than vital signs) Defaults can be unit-specific or the variables that contribute “most” to a change or high probability Ability to see any variables that contribute to the model as well as anything abnormal (even if it does not contribute to the statistical model)
Treatments and Interventions	Want to see what has been done to mitigate event risk Selected treatments should relate to problem being viewed (eg, antibiotics for sepsis but not falls)	Might need to be unit-specific
Ranking	Rank patients in descending order of probability Might not work without a consideration of “context” or “baseline” Would need different view for charge nurse vs bedside nurse vs RRT (prefer to see only those in one’s care)
Alert Notification	See or read why the prediction score changed (ie, what individual value[s] changed) Accompany alerts with a recommended action Review tool at beginning of shift (eg, during shift change) and then be notified of changes Alerts for exceeding an absolute value threshold as well as percent change Should be specific to unit/department	Consider building statistics for 12–24 h early so that nurses are “helping the next shift out” as opposed to “depending on a statistical model to tell them how to do their job”
Color Scheme	Red/yellow/green acceptable if also including the actual number Several requested flashing or blinking	Consider color-blind persons Font size to represent magnitude Flashing not recommended
Medium	Dashboard displays, especially for low-risk patients Mobile-friendly option (eg, cellphone) Prefer information available at the bedside for RRT arrival (possibly something where RRT could obtain information while en route) Ability to click elements or “zoom in” to see details
Communication	Capture data in real time from EHR Ability to send screenshots to EHR, RRT, provider, and/or charge nurse

Notes: EHR = electronic health record; RRT = rapid response team. Expert evaluation refers to heuristic usability considerations provided by human-computer interaction and design experts.