Emergency department pathology order support tool (ED POST): a protocol using qualitative inquiry to inform design and development of a prototype to reduce low value care

Laboratory tests have an important role in informing diagnosis and aiding in the determination of appropriate courses of management and/or treatment in the Emergency Department setting. Over-ordering of laboratory tests can lead to increased costs and/or unnecessary patient procedures, whilst under-ordering can lead to patient safety concerns and/or diagnostic error. Reducing over/under ordering through appropriate use of pathology has the potential to improve patient safety and/or reduce healthcare costs. As a dynamic electronic decision support tool, the Emergency Department Pathology Order Support Tool (ED POST) aims to facilitate effective ordering of pathology tests. This protocol details the methodological approach to be undertaken during the design and development of ED POST, commencing from the outset of the initial development of a prototype design. The research will undertake qualitative methods (interviews, focus group, and think-aloud observations) to develop business process models through collaboration with Emergency Department clinicians. The pre-development research will constitute stage 1 of the approach, with stage 2 focussed on evaluating the utility, usability and business process impact of the prototype to refine the prototype's design. The collaborative and qualitative multi-method approach aims to elucidate an in-depth understanding of existing laboratory test ordering and decision-making processes in the Emergency Department, serving to inform the development of a relevant and practicable solution. Health researchers and digital health developers can draw on this approach to inform research planning activities for health information technology intervention design projects and can follow the developmental journey of ED POST as its outcomes are reported in the literature.