Applying a human factors approach to improve usability of a decision support system in tele-nursing

Tariq, Amina, Westbrook, Johanna, Byrne, Mary, Robinson, Maureen, & Baysari, Melissa T. (2016) Applying a human factors approach to improve usability of a decision support system in tele-nursing. Collegian. (In Press)

[img] Accepted Version (PDF 1MB)
Administrators only | Request a copy from author
Available under License Creative Commons Attribution Non-commercial No Derivatives 4.0.

View at publisher



To evaluate usability of a decision support system for telephone triage nurses.


Telephone triage by nurses has become an internationally accepted form of health service delivery to cope with increasing demands on primary and emergency care. Decision support software systems are used by nurses to facilitate the telephone triage process, yet, the usability of these systems is rarely assessed.


We applied a multi-method human factors approach to evaluate the usability of decision support software used by Healthdirect Australia nurses during telephone triage. Methods included: (1) stakeholder discussions; (2) heurstic analysis by two independent experts across ten usability heuristics; and (3) interviews with system end users (n = 9). A list of heuristic violations with their severity ratings was developed. Qualitative content analysis of the interview transcripts was undertaken to validate the results of the heuristic evaluation.


Forty one unique heuristic violations were identified in the interface design of the decision support software with median severity of 2.25 (range 0–4, with 0 = no problem to 4 = catastrophic problem). The highest number of violations was observed for flexibility and efficiency of use (n = 12, median severity = 2.5) and for aesthetic and minimalist design (n = 11, median severity = 2). Interviews with nurses verified many of the violations identified in the heuristic analysis. Improving the navigational design of the system for flexibility and efficiency of use was identified as necessary by both the experts and end users.


In adopting a multi-method human factors approach, we identified a number of system design features which may be impacting on the safety and efficiency of the nurse telephone triage process. Addressing the identified usability issues and using feedback from end-users to modify the decision support system would optimise system use and so improve the triage process.

Impact and interest:

1 citations in Scopus
Search Google Scholar™

Citation counts are sourced monthly from Scopus and Web of Science® citation databases.

These databases contain citations from different subsets of available publications and different time periods and thus the citation count from each is usually different. Some works are not in either database and no count is displayed. Scopus includes citations from articles published in 1996 onwards, and Web of Science® generally from 1980 onwards.

Citations counts from the Google Scholar™ indexing service can be viewed at the linked Google Scholar™ search.

ID Code: 95866
Item Type: Journal Article
Refereed: Yes
Keywords: Telephone triage; Decision support; Nurses; Usability; Human factors
DOI: 10.1016/j.colegn.2016.02.001
ISSN: 1322-7696
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Current > Schools > School of Public Health & Social Work
Copyright Owner: Copyright 2016 Australian College of Nursing Ltd.
Copyright Statement: This manuscript version is made available under the CC-BY-NC-ND 4.0 license
Deposited On: 30 May 2016 23:04
Last Modified: 05 Jun 2016 04:48

Export: EndNote | Dublin Core | BibTeX

Repository Staff Only: item control page