Wong Adrian, Berenbrok Lucas A, Snader Lauren, Soh Yu Hyeon, Kumar Vishakha K, Javed Muhammad Ali, Bates David W, Sorce Lauren R, Kane-Gill Sandra L
Beth Israel Deaconess Medical Center, Department of Pharmacy, Boston, MA.
University of Pittsburgh, School of Pharmacy, Pittsburgh, PA.
Crit Care Explor. 2023 Aug 25;5(9):e0967. doi: 10.1097/CCE.0000000000000967. eCollection 2023 Sep.
Clinical decision support systems (CDSSs) are used in various aspects of healthcare to improve clinical decision-making, including in the ICU. However, there is growing evidence that CDSS are not used to their full potential, often resulting in alert fatigue which has been associated with patient harm. Clinicians in the ICU may be more vulnerable to desensitization of alerts than clinicians in less urgent parts of the hospital. We evaluated facilitators and barriers to appropriate CDSS interaction and provide methods to improve currently available CDSS in the ICU.
Sequential explanatory mixed-methods study design, using the BEhavior and Acceptance fRamework.
International survey study.
PATIENT/SUBJECTS: Clinicians (pharmacists, physicians) identified via survey, with recent experience with clinical decision support.
An initial survey was developed to evaluate clinician perspectives on their interactions with CDSS. A subsequent in-depth interview was developed to further evaluate clinician (pharmacist, physician) beliefs and behaviors about CDSS. These interviews were then qualitatively analyzed to determine themes of facilitators and barriers with CDSS interactions.
A total of 48 respondents completed the initial survey (estimated response rate 15.5%). The majority believed that responding to CDSS alerts was part of their job (75%) but felt they experienced alert fatigue (56.5%). In the qualitative analysis, a total of five facilitators (patient safety, ease of response, specificity, prioritization, and feedback) and four barriers (excess quantity, work environment, difficulty in response, and irrelevance) were identified from the in-depth interviews.
In this mixed-methods survey, we identified areas that institutions should focus on to improve appropriate clinician interactions with CDSS, specific to the ICU. Tailoring of CDSS to the ICU may lead to improvement in CDSS and subsequent improved patient safety outcomes.
临床决策支持系统（CDSS）被应用于医疗保健的各个方面，以改善临床决策，包括在重症监护病房（ICU）。然而，越来越多的证据表明，CDSS并未得到充分利用，常常导致警报疲劳，而警报疲劳已与患者伤害相关联。与医院中病情不太紧急科室的临床医生相比，ICU的临床医生可能更容易对警报脱敏。我们评估了促进适当CDSS交互的因素和障碍，并提供了改进ICU现有CDSS的方法。
采用行为与接受框架的序贯解释性混合方法研究设计。
国际调查研究。
患者/受试者：通过调查确定的临床医生（药剂师、医生），近期有临床决策支持方面的经验。
开展了一项初始调查，以评估临床医生对其与CDSS交互情况的看法。随后进行了深入访谈，以进一步评估临床医生（药剂师、医生）对CDSS的信念和行为。然后对这些访谈进行定性分析，以确定与CDSS交互的促进因素和障碍的主题。
共有48名受访者完成了初始调查（估计回复率为15.5%）。大多数人认为对CDSS警报做出响应是他们工作的一部分（75%），但感觉自己经历了警报疲劳（56.5%）。在定性分析中，从深入访谈中总共确定了五个促进因素（患者安全、响应容易程度、特异性、优先级和反馈）和四个障碍（数量过多、工作环境、响应困难和无关性）。
在这项混合方法调查中，我们确定了机构应关注的领域，以改善ICU临床医生与CDSS的适当交互。针对ICU量身定制CDSS可能会改进CDSS，并随后改善患者安全结果。
