(1331) Usability Assessment of a Standardized ECMO Clot Deposition Documentation Tool

Introduction: Anticoagulation guidelines juxtapose circuit clot burden against patients’ bleeding risk on extracorporeal membrane oxygenation (ECMO) support. A standard nomenclature is lacking, causing a disconnect in applying objective clinical guidelines based on subjective evaluation. We aim to bridge by implementing and assessing the usability of a standardized documentation tool of clot burden.

Methods: We created an electronic medical record (EMR) tool evaluating ECMO circuit depositions’ type, size, color, progression, and location mapped to circuitry schematics. A pre-implementation survey presented a photographed sample for the ECMO team to evaluate using the tool. They then completed a validated System Usability Scale (SUS) questionnaire and free-form feedback. Based on the results, the tool was modified to roll over prior documentation while allowing modifications, and the drop-down menu for clot location linked to a diagram with the location encircled.

Results: 56 of 78 (72%) bedside specialists completed the pre-implementation survey. 96.5% were nursing specialists with ECMO experience of 1-3 years (28.8%), 3-5 and 5-10 years (23.1% each). 35.7% affirmed they “would like to use the system frequently” and 34.5% that “the system was easy to use”. 50.9% responded that the system could be learned quickly and 80% felt it could be learned without the need of technical support. Free text feedback elucidated that the consistent, specific verbiage of the tool is an advantage, but the tool led to excessive data collection and heavy documentation burden on the user.

Conclusions: This project evaluates the usability of a standardized EMR tool assessing ECMO clot burden. Pre-implementation data highlighted the documentation burden of the tool on the user. Using this data we adjusted the tool to improve efficiency by carrying forward initial deposition documentation and allowing for revision of traits as they evolve. This maintains the advantage of a standardized linguistic framework while limiting documentation burden. Now live, each circuit is evaluated hourly by two ECMO specialists and per shift by a perfusionist. Post-implementation analysis will reexamine the usability of the tool with the same SUS survey and an inter-rater reliability analysis to assess the tool’s consistency and reproducibility.