C-SCHaRR, Birmingham City University, Birmingham, UK
School of Human and Health Sciences, University of Huddersfield, Bradford, West Yorkshire, UK.
BMJ Open. 2023 Jan 17;13(1):e061298. doi: 10.1136/bmjopen-2022-061298.
The Computer-Aided Risk Score for Mortality (CARM) estimates the risk of in-hospital mortality following acute admission to the hospital by automatically amalgamating physiological measures, blood tests, gender, age and COVID-19 status. Our aims were to implement the score with a small group of practitioners and understand their first-hand experience of interacting with the score in situ.
Pilot implementation evaluation study involving qualitative interviews.
This study was conducted in one of the two National Health Service hospital trusts in the North of England in which the score was developed.
Medical, older person and ICU/anaesthetic consultants and specialist grade registrars (n=116) and critical outreach nurses (n=7) were given access to CARM. Nine interviews were conducted in total, with eight doctors and one critical care outreach nurse.
Participants were given access to the CARM score, visible after login to the patients' electronic record, along with information about the development and intended use of the score.
Four themes and 14 subthemes emerged from reflexive thematic analysis: (1) current use (including support or challenge clinical judgement and decision making, communicating risk of mortality and professional curiosity); (2) barriers and facilitators to use (including litigation, resource needs, perception of the evidence base, strengths and limitations), (3) implementation support needs (including roll-out and integration, access, training and education); and (4) recommendations for development (including presentation and functionality and potential additional data). Barriers and facilitators to use, and recommendations for development featured highly across most interviews.
Our in situ evaluation of the pilot implementation of CARM demonstrated its scope in supporting clinical decision making and communicating risk of mortality between clinical colleagues and with service users. It suggested to us barriers to implementation of the score. Our findings may support those seeking to develop, implement or improve the adoption of risk scores.
计算机辅助死亡率风险评分（CARM）通过自动合并生理指标、血液检查、性别、年龄和 COVID-19 状态，估计患者住院期间的死亡率风险。我们的目的是让一小部分医生实施该评分，并了解他们在现场与评分互动的第一手经验。
涉及定性访谈的试点实施评估研究。
本研究在英格兰北部的两个国民保健服务医院信托基金之一进行，该评分在此开发。
医疗、老年和 ICU/麻醉顾问以及专科住院医师（n=116）和重症护理外联护士（n=7）被授予 CARM 访问权限。总共进行了 9 次访谈，涉及 8 名医生和 1 名重症护理外联护士。
参与者可以访问 CARM 评分，该评分在登录患者电子记录后可见，同时还可以获得有关评分的开发和预期用途的信息。
从反思性主题分析中出现了四个主题和 14 个子主题：（1）当前使用（包括支持或挑战临床判断和决策、沟通死亡率风险和职业好奇心）；（2）使用的障碍和促进因素（包括诉讼、资源需求、对证据基础的看法、优势和局限性）；（3）实施支持需求（包括推出和整合、访问、培训和教育）；（4）发展建议（包括演示文稿和功能以及潜在的其他数据）。使用的障碍和促进因素以及发展建议在大多数访谈中都占据了重要地位。
我们对 CARM 试点实施的现场评估表明，它在支持临床决策和在临床同事和服务用户之间沟通死亡率风险方面具有广泛的应用前景。它向我们暗示了实施该评分的障碍。我们的发现可能为那些寻求开发、实施或改进风险评分采用的人提供支持。
