Workload and workflow implications associated with the use of electronic risk assessment tools used by health professionals in general practice: a scoping review

Problem

Electronic risk assessment tools are increasingly available to assist GPs in their clinical decision making in relation to diagnosis and management of a range of health conditions. It is unclear whether the use of such tools has an impact on GP workload and workflow. This scoping review aimed to identify the available evidence on the use of electronic risk assessment tools by health professionals in general practice and their impact on workload and workflow.

Approach

A scoping review was carried out using the Arksey and O’Malley methodological framework. The search strategy was developed iteratively, with three main aspects: general practice/primary care contexts, risk assessment/decision support tools, and workload-related factors. Three databases were searched, in 2019, updated in 2021, covering articles published since 2009: Medline (Ovid), HMIC (Ovid) and Web of Science (TR). Screening was completed by two reviewers, and data extracted from the identified articles was analysed.

Findings

The search resulted in 5,594 references, with 91 articles remaining after screening. Of these, 33 were USA studies, with UK and Australian studies comprising another third (20 and 11 studies respectively). A further 22 studies originated between Canada and Europe, with the remaining few studies conducted in New Zealand (2) , South Africa (2) and Malaysia (1). The studies all aimed to examine use of electronic tools and reported findings which included those related to impacts on aspects of workload, including consultation time (though this was often not the focus). Most studies were qualitative and exploratory in nature, reporting healthcare professionals’ subjective perceptions of time as opposed to objectively-measured time spent using electronic tools and lengths of consultations. Others reported workload-related findings included impacts on cognitive workload, workflow and dialogue with patients, and clinicians’ experience of ‘alert fatigue’.

Consequences

The published literature on the use of electronic risk assessment tools in general practice shows that limited efforts have focused on the quantitative impact of such tools on workload and workflow in consultations. The majority of studies reflected health professionals’ perceptions that using such tools will involve additional time, workload and disruptions to workflow. Further research to provide objective, quantitative measurements of consultation lengths, would be useful to address whether these perceptions are justified.