Development of the ERATbi App, a Clinical Decision Support System for Early Recovery After Traumatic Brain Injury in the ICU: Usability Study

Abstract

Background: Early rehabilitation in neurocritical care is often underutilized due to fragmented workflows, interdisciplinary coordination challenges, and the absence of structured digital decision support. Traditional clinical decision support systems (CDSS) often address single domains and lack adaptability to the dynamic, multiprofessional workflows of intensive care units (ICUs).

Objective: To develop and evaluate the usability of the ERATbi App (Early Recovery After Traumatic Brain Injury App), a modular, tablet-based CDSS was designed to streamline early rehabilitation planning and strengthen interdisciplinary coordination for patients with moderate-to-severe traumatic brain injury (TBI) in intensive care settings.

Methods: The ERATbi app integrates four functional modules-delirium risk management, precision nutrition, stepwise early mobilization, and respiratory care for rib fractures-into a unified interface. A simulation-based usability study was conducted with 18 ICU clinicians. Evaluation metrics included System Usability Scale (SUS) scores, task completion rates, error rates, and task durations. Additional user feedback was collected via a 5-point Likert satisfaction survey and semi-structured qualitative interviews.

Results: The app demonstrated high usability (mean SUS score 83.6, SD 7.4), a 100% (18/18 participants) task completion rate, and a low error rate (4.2%). Average module completion time was 6.5 minutes, and user satisfaction was high (mean 4.7, SD 0.5). Users highlighted the value of the app's visual logic, real-time alerts, adaptive thresholds, and modular workflow integration for enhancing team coordination and decision consistency.

Conclusions: The ERATbi app demonstrated excellent usability, high user satisfaction, and clinical relevance in simulated ICU workflows. Its logic-driven, workflow- integrated design may support scalable, interdisciplinary implementation of early rehabilitation in neurocritical care settings.

Keywords: brain injuries, traumatic; decision support systems; human engineering; intensive care units; rehabilitation, early; usability testing.