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Title: Clinical decision-making in acute paediatrics : evaluation of the impact of an internet-delivered paediatric decision support system
Author: Ramnarayan, Padmanabhan
ISNI:       0000 0004 2675 8813
Awarding Body: Imperial College London
Current Institution: Imperial College London
Date of Award: 2009
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A newer generation diagnostic aid (Isabel), capable of rapid advice provision using a simplified user interface, was developed at St Mary's Hospital in 2000. This thesis describes a series of evaluations conducted to explore Isabel's effects on diagnostic decision-making in acute paediatric practice. Preliminary assessment of system performance by the developers using a wide variety of hypothetical and real cases indicated that Isabel demonstrated significant accuracy with minimal usage time. In the next stage of evaluation, clinicians used the system to make decisions on a balanced set of cases in a simulated field study. Changes in the quality of diagnostic assessment by various grades of subjects were measured before and after Isabel consultation. Since no suitable metric was available to perform this measurement, a new reliable and valid score was developed as part of this investigation. All grades of subjects benefited from the use of the diagnostic aid in easy and difficult cases. Despite variability in the clinical features input into the Isabel system, diagnostic suggestions did not vary significantly across subjects. In the next step of evaluation, an assessment of Isabel's impact on junior doctors' decision making was performed in a multi-centre clinical trial at four paediatric sites. Subjects improved their diagnostic performance by including a number of important diagnoses in their workup after system consultation. Numerous technical, cultural and systematic barriers presented the routine use of decision support. Findings from this project provide valuable insights into how newer generation diagnostic aids can be designed and used to achieve a reduction in diagnostic error.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available