Applying human factors principles to alert design increases efficiency and reduces prescribing errors in a scenario-based simulation.

Russ AL, Zillich AJ, Melton BL, Russell SA, Chen S, Spina JR, Weiner M, Johnson EG, Daggy JK, McManus MS, Hawsey JM, Puleo AG, Doebbeling BN, Saleem JJ. Applying human factors principles to alert design increases efficiency and reduces prescribing errors in a scenario-based simulation. Journal of the American Medical Informatics Association : JAMIA. 2014 Oct 1; 21(e2):e287-96.

Related HSR&D Project(s)

• PPO 09-298 – Redesigning Medication Alerts to Support Prescriber Workflow
• CDA 11-214 – Improving Medication Safety through Human Factors and Informatics Research
• CDA 09-024 – Circumventing Health IT: Identifying Patient Safety Risks

Dimensions for VA is a web-based tool available to VA staff that enables detailed searches of published research and research projects.

If you have VA-Intranet access, click here for more information vaww.hsrd.research.va.gov/dimensions/

VA staff not currently on the VA network can access Dimensions by registering for an account using their VA email address.    Search Dimensions for VA for this citation
* Don't have VA-internal network access or a VA email address? Try searching the free-to-the-public version of Dimensions

Search for Abstract from PubMed

---

Abstract:

OBJECTIVE: To apply human factors engineering principles to improve alert interface design. We hypothesized that incorporating human factors principles into alerts would improve usability, reduce workload for prescribers, and reduce prescribing errors. MATERIALS AND METHODS: We performed a scenario-based simulation study using a counterbalanced, crossover design with 20 Veterans Affairs prescribers to compare original versus redesigned alerts. We redesigned drug-allergy, drug-drug interaction, and drug-disease alerts based upon human factors principles. We assessed usability (learnability of redesign, efficiency, satisfaction, and usability errors), perceived workload, and prescribing errors. RESULTS: Although prescribers received no training on the design changes, prescribers were able to resolve redesigned alerts more efficiently (median (IQR): 56 (47) s) compared to the original alerts (85 (71) s; p = 0.015). In addition, prescribers rated redesigned alerts significantly higher than original alerts across several dimensions of satisfaction. Redesigned alerts led to a modest but significant reduction in workload (p = 0.042) and significantly reduced the number of prescribing errors per prescriber (median (range): 2 (1-5) compared to original alerts: 4 (1-7); p = 0.024). DISCUSSION: Aspects of the redesigned alerts that likely contributed to better prescribing include design modifications that reduced usability-related errors, providing clinical data closer to the point of decision, and displaying alert text in a tabular format. Displaying alert text in a tabular format may help prescribers extract information quickly and thereby increase responsiveness to alerts. CONCLUSIONS: This simulation study provides evidence that applying human factors design principles to medication alerts can improve usability and prescribing outcomes.