Appl Clin Inform 2021; 12(01): 034-040
DOI: 10.1055/s-0040-1718757
Case Report

User-Centered Design in Pediatric Acute Care Settings Antimicrobial Stewardship

Michael J. Ward
1   Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States
Bryson Chavis
2   Clemson University, Clemson, South Carolina, United States
Ritu Banerjee
3   Division of Pediatric Infectious Diseases, Department of Pediatrics. Vanderbilt University Medical Center, Nashville, Tennessee, United States
Sophie Katz
3   Division of Pediatric Infectious Diseases, Department of Pediatrics. Vanderbilt University Medical Center, Nashville, Tennessee, United States
Shilo Anders
4   Center for Research & Innovation in Systems Safety, Department of Anesthesiology, Biomedical Informatics, & EECS, Vanderbilt University Medical Center, Nashville, Tennessee, United States
› Author Affiliations
Funding This work was supported by NIH K23 HL127130 and NSF 1757644. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health and the National Science Foundation. All authors had full access to all the data in the study and had final responsibility for the decision to submit for publication.


Background Antibiotic prescribing in ambulatory care centers is increasing. Previous research suggests that 20 to 50% of antibiotic prescriptions are either unnecessary or inappropriate. Unnecessary antibiotic consumption can harm patients by increasing antibiotic resistance and drug-associated toxicities, and the reasons for such use are multifactorial. Antimicrobial Stewardship Programs (ASP) were developed to guide better use of antibiotics. A core element of ASP is to provide feedback to clinical providers. To create clinically meaningful feedback, user-center design (UCD) is a robust approach to include end-users in the design process to improve systems.

Objective The study aimed to take a UCD approach to developing antibiotic prescribing feedback through input from clinicians in two ambulatory care settings.

Methods We conducted two group prototyping sessions with pediatric clinicians who practice in the emergency department and urgent care settings at a tertiary care children's hospital. Participants received background on the problem of antibiotic prescribing and then were interviewed about their information needs, perceived value, and desired incentives for a prescribing feedback system. Sessions concluded with their response and recommendations to sample sections of an antibiotic feedback report including orienting material, report detail, targeted education, and resources.

Results A UCD approach was found to be highly valuable in the development of a feedback mechanism that is viewed as desirable by clinicians. Clinicians preferred interpreting the data themselves with aids such as diagrams and charts over the researcher concluded statements about the clinician's behavior. Specific feedback that clinicians considered redundant were removed from the model if preexisting alerts were established.

Conclusion Integrating a UCD approach in developing ASP feedback identified desirable report characteristics that substantially modified preliminary wireframes for feedback. Future research will evaluate the clinical effectiveness of our feedback reports in outpatient settings.

Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki on ethical principles for medical research involving human subjects and was reviewed by the Vanderbilt University Institutional Review Board.

Publication History

Received: 29 January 2020

Accepted: 16 September 2020

Article published online:
20 January 2021

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