Cautiously optimistic: paediatric critical care nurses’ perspectives on data-driven algorithms in low-resource settings—a human-centred design study in Malawi

BMC Global and Public Health, vol. 2, pp. 80

Abstract

BACKGROUND: Paediatric critical care nurses face challenges in promptly detecting patient deterioration and delivering high-quality care, especially in low-resource settings (LRS). Patient monitors equipped with data-driven algorithms that monitor and integrate clinical data can optimise scarce resources (e.g. trained staff) offering solutions to these challenges. Poor algorithm output design and workflow integration, however, are important factors hindering successful implementation. This study aims to explore nurses' perspectives to inform the development of a data-driven algorithm and user-friendly interface for future integration into a continuous vital signs monitoring system for critical care in LRS. METHODS: Human-centred design methods, including contextual inquiry, semi-structured interviews, prototyping and co-design sessions, were carried out at the high-dependency units of Queen Elizabeth Central Hospital and Zomba Central Hospital in Malawi between March and July 2023. Triangulating these methods, we identified what algorithm could assist nurses and used co-creation methods to design a user interface prototype. Data were analysed using qualitative content analysis. RESULTS: Workflow observations demonstrated the effects of personnel shortages and limited monitor equipment for vital signs monitoring. Interviews identified four themes: workload and workflow, patient prioritisation, interaction with guardians, and perspectives on data-driven algorithms. The interviews emphasised the advantages of predictive algorithms in anticipating patient deterioration, underlining the need to integrate the algorithm's output, the (constant) monitoring data, and the patient's present clinical condition. Nurses preferred a scoring system represented with familiar scales and colour codes. During co-design sessions, trust, usability and context specificity were emphasised as requirements for these algorithms. Four prototype components were examined, with nurses favouring scores represented by colour codes and visual representations of score changes. CONCLUSIONS: Nurses in the LRS studied, perceived that data-driven algorithms, especially for predicting patient deterioration, could improve the provision of critical care. This can be achieved by translating nurses' perspectives into design strategies, as has been carried out in this study. The lessons learned were summarised as actionable pre-implementation recommendations for the development and implementation of data-driven algorithms in LRS.

Authors 12

1. Margot M. Rakers Aachen Department of Public Health and Primary Care National eHealth Living Lab

   Leiden University Medical Center

   Affiliation as printed

   Department of Public Health and Primary Care, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands

   National eHealth Living Lab (NeLL), Leiden University Medical Center, Leiden, The Netherlands

2. Daniel Mwale

   Kamuzu University of Health Sciences

   Affiliation as printed

   Kamuzu University of Health Sciences, Blantyre, Malawi

3. Lieke de Mare
   Affiliation as printed

   GOAL 3, Hertogenbosch, The Netherlands

4. Lezzie Chirambo

   Kamuzu University of Health Sciences

   Affiliation as printed

   Kamuzu University of Health Sciences, Blantyre, Malawi

5. Bart Bierling
   Affiliation as printed

   GOAL 3, Hertogenbosch, The Netherlands

6. Alice Likumbo
   Affiliation as printed

   Training Research Unit of Excellence (TRUE), Blantyre, Malawi

7. Josephine Langton

   Queen Elizabeth Central Hospital · Kamuzu University of Health Sciences

   Affiliation as printed

   Kamuzu University of Health Sciences, Blantyre, Malawi

   Paediatric Department, College of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi

8. Niels Henrik Chavannes Aachen Department of Public Health and Primary Care National eHealth Living Lab

   Leiden University Medical Center

   Affiliation as printed

   Department of Public Health and Primary Care, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands

   National eHealth Living Lab (NeLL), Leiden University Medical Center, Leiden, The Netherlands

9. Hendrikus J. A. van Os Aachen Department of Public Health and Primary Care National eHealth Living Lab

   Leiden University Medical Center · Queen Elizabeth Central Hospital

   Affiliation as printed

   Department of Public Health and Primary Care, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands

   National eHealth Living Lab (NeLL), Leiden University Medical Center, Leiden, The Netherlands

   Paediatric Department, College of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi

10. Job C. J. Calis

    Amsterdam UMC Location University of Amsterdam · Emma Kinderziekenhuis · Queen Elizabeth Central Hospital

    Affiliation as printed

    Department of Paediatric Intensive Care, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands

    Paediatric Department, College of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi

    GOAL 3, Hertogenbosch, The Netherlands

11. Kiran H. J. Dellimore Aachen National eHealth Living Lab

    Leiden University Medical Center

    Affiliation as printed

    GOAL 3, Hertogenbosch, The Netherlands

    National eHealth Living Lab (NeLL), Leiden University Medical Center, Leiden, The Netherlands

12. María José Villalobos-Quesada corresponding Aachen Department of Public Health and Primary Care National eHealth Living Lab

    Leiden University Medical Center

    Affiliation as printed

    Department of Public Health and Primary Care, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands. m.j.villalobos_quesada@lumc.nl

    National eHealth Living Lab (NeLL), Leiden University Medical Center, Leiden, The Netherlands. m.j.villalobos_quesada@lumc.nl