Interface design features of clinical decision support systems for real-time detection of deterioration: A scoping review.

Background: Clinical decision support systems (CDSS) can support clinicians with the timely detection of patients' clinical deterioration, however, less than half of clinical decision support (CDS) systems implemented for clinical deterioration are used by clinicians. Poor design of CDS systems has emerged as a contributing factor.

Objective: The aim of this study was to 1) identify interface design features that have been used in CDS systems for real-time detection of clinical deterioration; (2) determine which interface design features are preferred by clinicians; and (3) examine other design features (external to the interface) which influence CDS acceptance.

Methods: Three databases (Medline, Scopus and CINAHL) were searched to identify relevant studies. All studies that met the eligibility criteria were included. A qualitative narrative synthesis was undertaken.

Results: Of 24 eligible articles, 17 described CDS systems in the form of a dashboard and 7 described alerts. Of the 17 dashboards, graphs and tables were the most used interface design features to display vital signs. Colour was the most frequently used interface design feature to signal the presence of deterioration with half of colour-coded dashboards using a traffic light schema to classify patient risk level. Clinicians preferred dashboards that included both graphs and tables. Clinicians have expressed that they were disinclined to use CDS systems with manual recording of vital signs and high alert frequency.

Conclusions: This scoping review uncovered wide variability in design features across CDS systems for real-time detection of deterioration. Our research calls for better adherence to reporting checklists when reporting on interface designs, and the development of design guidelines to guide interface designs of CDS systems for detecting deterioration in real-time. Our scoping review may serve as a preliminary guide for the design of future CDS systems for detecting deterioration.