User Centered Design in the Creation of a Surgical Intensive Care Log

The Residency Review Committee (RRC) requires that general surgery residents document their Surgical Intensive Care Unit (SICU) experiences. To satisfy these requirements we created a web based intranet log to make it easier for residents to track their patients and determine when these requirements were complete. A premium was put on usability to promote acceptance by surgical residents. A prototype web site was designed with input from an attending general surgeon. Three general surgery residents were selected to participate in the iterative design phase. They went through three iterations using a "think-aloud" method while performing tasks on the prototype web site. Each iteration led to improvements to the web site. In a comparison test, a group of seven medical students performed 14 typical web site tasks using both the prototype and the final versions. They were asked to complete a Questionnaire for User Interaction Satisfaction (QUIS) for each version. The time for completion of these tasks was also recorded. The user interaction satisfaction did not show any improvement (F(1,6)=0.13, p=0.912). Similarly, there was no improvement in times for delete and add tasks ( Delete F(1,5) = 0.949, p=0.375, Add F(1,5)=0.267, p=0.628 ); however, the time to complete edit tasks was faster for the final version of the web site (F (1,5)= 14.3, p=0.013). The primary reason for not detecting other differences between the two web sites is likely that the comparison study did not have sufficient power. This was suggested by the participants whose comments favored the final version over the prototype as well as a trend of consistently higher mean subset scores in the final version. The results indicate that differences may be seen when more complex tasks are completed (editing information) versus the two simpler tasks (adding or deleting a patient record in a web site). Future studies should focus on the impact of navigation strategies on speed and data warehouse approaches to creating the application. This study shows the benefits of using an iterative design approach to create a usable web site and demonstrates the importance of further research in the field of usability.