ArticleApplied clinical informatics2026
Optimizing Clinical Decision Support for Antibiotic Prescribing in Pediatric Acute Respiratory Tract Infections: A Usability Study.
Article in Applied clinical informatics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
5 authors.
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Abstract
Background: Inappropriate antibiotic prescribing contributes to antimicrobial resistance. Antimicrobial stewardship (AMS) programs increasingly rely on electronic health record (EHR)-based clinical decision support (CDS) alerts to guide evidence-based care, yet poorly designed alerts can increase cognitive burden and contribute to burnout. Usability testing offers a structured approach to improving alert design and adoption. Objectives: This study aimed to evaluate and iteratively refine interruptive CDS alerts developed to support appropriate antibiotic prescribing for pediatric acute respiratory tract infections (ARTIs) within an urban academic health system as part of a larger implementation project. Methods: Twelve providers participated in four waves of virtual usability testing using scripted clinical scenarios reflecting common workflows. Participants interacted with three clinical alerts and one design-focused scenario. Quantitative outcomes included task effectiveness, efficiency, satisfaction, and perceived difficulty. Qualitative feedback was gathered via think-aloud techniques and synthesized using a "rainbow spreadsheet." Iterative modifications were implemented between waves until thematic saturation was achieved. Results: Task completion across scenarios was high (83.3%). Effectiveness and efficiency improved over waves, and satisfaction increased when alerts embedded actionable tasks such as ordering tests, adding diagnoses, or switching antibiotics. Participants emphasized the importance of clear, concise text and intuitive defaults. Including links to evidence-based guidelines improved trust. Alert refinements reduced cognitive load and improved workflow alignment. Conclusion: Rapid, iterative usability testing substantially improved the clarity and workflow integration of interruptive CDS alerts. Incorporating usability evaluation into CDS stewardship efforts can enhance adoption, reduce alert fatigue, and strengthen implementation of evidence-based practices.
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