Usability testing of a user-centered clinical decision support tool about asymptomatic bacteriuria and urinary tract infections in older adults
Abstract
Abstract Objective: We evaluated usability of a web-based clinical decision support tool designed to support antibiotic stewardship by helping clinicians differentiate asymptomatic bacteriuria from true urinary tract infections. Design: Mixed methods usability evaluation with qualitative think-aloud sessions and survey. Setting: Private academic medical center. Participants: Clinicians who evaluate and treat older adults with suspected asymptomatic bacteriuria or urinary tract infections. Methods: Participants used the tool to assess three standardized clinical scenarios, verbalizing their thoughts as they used the tool, followed by a short debrief interview and survey. Transcripts of audio recordings were analyzed using qualitative content analysis across four usability domains: navigation, content, functionality, and layout. Results: Seven clinicians (four attending physicians, three advanced practice providers) practicing in primary care, outpatient, and inpatient settings participated. The mean System Usability Score was 85.4 (SD = 10.5; range 75–100), indicating “excellent” usability. Three qualitative themes emerged: (1) positive responses to the tool’s speed, simple entry, and reassuring guidance; (2) content-related challenges, including missing symptoms, unclear fever thresholds, undefined terminology, and absent caveats for allergies, resistant organisms, or unique populations; and (3) suggested navigational changes, including links opening in new tabs, preserving entered clinical data, and reorganizing the symptom checklist. Participants highlighted electronic health record integration as necessary for sustained use. Conclusions: Participants found the tool usable and clinically valuable, particularly when infectious disease expertise is limited. Targeted refinements will be addressed before testing in a randomized study with a larger more representative sample. Future work will also pursue electronic health record integration via an embedded hyperlink for broader deployment.