Impact of Mobile Device-Based Clinical Decision Support Tool on Guideline Adherence and Mental Workload

Acad Pediatr. 2019 Sep-Oct;19(7):828-834. doi: 10.1016/j.acap.2019.03.001. Epub 2019 Mar 7.


Objective: To evaluate the individual-level impact of an electronic clinical decision support (ECDS) tool, PedsGuide, on febrile infant clinical decision making and cognitive load.

Methods: A counterbalanced, prospective, crossover simulation study was performed among attending and trainee physicians. Participants performed simulated febrile infant cases with use of PedsGuide and with standard reference text. Cognitive load was assessed using the NASA-Task Load Index (NASA-TLX), which determines mental, physical, temporal demand, effort, frustration, and performance. Usability was assessed with the System Usability Scale (SUS). Scores on cases and NASA-TLX scores were compared between condition states.

Results: A total of 32 participants completed the study. Scores on febrile infant cases using PedsGuide were greater compared with standard reference text (89% vs 72%, P = .001). NASA-TLX scores were lower (ie, more optimal) with use of PedsGuide versus control (mental 6.34 vs 11.8, P < .001; physical 2.6 vs 6.1, P = .001; temporal demand 4.6 vs 8.0, P = .003; performance 4.5 vs 8.3, P < .001; effort 5.8 vs 10.7, P < .001; frustration 3.9 vs 10, P < .001). The SUS had an overall score of 88 of 100 with rating of acceptable on the acceptability scale.

Conclusions: Use of PedsGuide led to increased adherence to guidelines and decreased cognitive load in febrile infant management when compared with the use of a standard reference tool. This study employs a rarely used method of assessing ECDS tools using a multifaceted approach (medical decision-making, assessing usability, and cognitive workload,) that may be used to assess other ECDS tools in the future.

Keywords: electronic clinical decision support; febrile infant; mental workload; pediatrics; usability.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Cell Phone*
  • Cognition
  • Decision Support Systems, Clinical*
  • Female
  • Fever / diagnosis*
  • Fever / etiology
  • Fever / therapy*
  • Guideline Adherence*
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Mental Fatigue / prevention & control*
  • Middle Aged
  • Patient Simulation
  • Workload
  • Young Adult