| CDSA impractical in emergency situations |
Child with convulsions was brought into the consultation room interrupting the current consultation. The clinician stopped using the tablet and managed the child providing the incorrect antibiotic class and dose |
Emergency button integrated so that emergency management guidance can easily be accessed at any point of the algorithm. |
| Understanding algorithm branches |
Why a patient reached a specific diagnosis was not always well understood by clinicians |
To improve understanding, and to have medAL-reader as a learning tool, efforts were made to simply present the decision tree logic for individual diagnostic and syndromic branches of the algorithm. |
| Some medicines not available at health facilities due to stock-outs |
Sometimes medicines recommended by national guidelines were not available |
Provide alternative medicines for most conditions in case the recommended one is not available. |
| Misunderstanding of the labelling of some clinical elements |
The labelling of some symptoms and signs were not well understood by the clinician |
Modification of labelling of some elements, clarification provided in the information button, and translation to local language |
| Some clinical signs not measured, especially when patients are many |
Many clinicians did not always measure required clinical signs (anthropometrics, temperature, respiratory rate) and could thus not continue with the algorithm |
Provide options to not measure some clinical signs and rather estimate the values (with warning that this is sub-optimal) to limit clinicians being ‘stuck’, to discourage false information to be entered, and to provide mentorship to those not measuring these signs |
| No clear identification of symptoms and signs that always result in severe disease / referral |
Clinicians selected variables that resulted in a severe diagnosis, parenteral antibiotics, and referral, for which the clinician did not agree with. |
Elements that result in the diagnosis of a severe disease and referral are highlighted |
