An Online Survey of Health Professionals’ Opinions Regarding Observation Charts

The current study was the second stage of a project funded by the Australian Commission for Quality and Safety in Health Care and Queensland Health to investigate the design and use of observation charts in recognising and managing patient deterioration, including the design and evaluation of a new adult observation chart that incorporated human factors principles. Improving the recognition and management of patients who deteriorate whilst in hospital is a frequently cited goal for patient safety. Changes in physiological observations or ‘vital signs’ commonly precede serious adverse medical events. Paper-based observation charts are the chief means of recording and monitoring changes to patients’ vital signs. One approach to improve the recognition and management of deteriorating patients is to improve the design of paper-based observation charts (note that the management of patient deterioration can potentially be affected by chart design if, for example, action plans are included on the chart). There is considerable variation in the design of observation charts in current use in Australia and a lack of empirical research on the performance of observation charts in general. The aim of the current study was to gauge the opinions of the population who actually use observation charts. We recruited a large sample of health professionals (N = 333) to answer general questions about the design of observation charts and specific questions about nine observation charts. The participants reported using observation charts daily, but only a minority reported having received any formal training in the use of such charts. In our previously-reported heuristic analysis of observation charts (1), we found that the majority of charts included a large number of abbreviations. In this survey, participants were asked to nominate which term they first thought of when seeing a particular abbreviation. Most abbreviations were overwhelmingly assigned the same meaning. However, some abbreviations had groups of participants nominating different terms for the same abbreviation. Participants were also asked to nominate their preferred terms for nine vital signs that commonly appear on observation charts. For some vital signs, there was a high level of agreement as to which term was easiest to understand; however, for other vital signs, there was no clearly preferred term. Participants were also asked about their chart design preferences both in terms of (a) recording observations and (b) detecting deterioration. In both instances, participants preferred the option to “Plot the value on a graph with graded colouring, where the colours correspond to a scoring system or graded responses for abnormality”. Participants’ preference was in line with what a human factors approach would recommend (i.e. charts with a colour-coded track and trigger system). In the final sections of the survey, participants were first asked to respond to 13 statements regarding the design of their own institution’s current observation chart, and then to respond to the same 13 statements for one of nine randomly-assigned observation charts. The nine observation charts included the new Adult Deterioration Detection System (ADDS) chart and eight charts of “good”, “average”, or “poor” design quality from the heuristic analysis. Participants’ mean aggregated rating across the 13 items for their institution’s current observation chart was close to the scale’s mid-point, 3 = neutral. For the assigned charts, there was a statistically significant effect of chart type on the aggregated rating. The a priori “poor” quality charts were each rated as having a significantly poorer design compared with each of the other charts (collectively, the a priori “average” and “good” quality charts). There was partial support for our hypothesis that health professionals would rate the “good” charts as having better design, compared to the “average” and “poor” charts. In conclusion, the online survey served two main purposes. First, it collected quantitative data on health professionals’ general preferences regarding aspects of the design of observation charts. This information informed the design of the ADDS chart and could also be used by other chart designers to produce more user-friendly hospital charts. Second, the online survey enabled health professionals to rate the design of the new ADDS chart as well as eight existing charts of varying quality. Overall, health professionals agreed with our human factors-based rating with regards to the “poor” quality charts. However, the health professionals did not differentiate between the “average” and “good” quality charts in their ratings