Nuffield Department of Primary Care Health Sciences, Medical Division, University of Oxford, Oxford, United Kingdom.
National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, United Kingdom.
JMIR Hum Factors. 2024 Oct 15;11:e56949. doi: 10.2196/56949.
BACKGROUND: Sepsis is a common cause of serious illness and death. Sepsis management remains challenging and suboptimal. To support rapid sepsis diagnosis and treatment, screening tools have been embedded into hospital digital systems to appear as digital alerts. The implementation of digital alerts to improve the management of sepsis and deterioration is a complex intervention that has to fit with team workflow and the views and practices of hospital staff. Despite the importance of human decision-making and behavior in optimal implementation, there are limited qualitative studies that explore the views and experiences of health care professionals regarding digital alerts as sepsis or deterioration computerized clinician decision support systems (CCDSSs). OBJECTIVE: This study aims to explore the views and experiences of health care professionals on the use of sepsis or deterioration CCDSSs and to identify barriers and facilitators to their implementation and use in National Health Service (NHS) hospitals. METHODS: We conducted a qualitative, multisite study with unstructured observations and semistructured interviews with health care professionals from emergency departments, outreach teams, and intensive or acute units in 3 NHS hospital trusts in England. Data from both interviews and observations were analyzed together inductively using thematic analysis. RESULTS: A total of 22 health care professionals were interviewed, and 12 observation sessions were undertaken. A total of four themes regarding digital alerts were identified: (1) support decision-making as nested in electronic health records, but never substitute professionals' knowledge and experience; (2) remind to take action according to the context, such as the hospital unit and the job role; (3) improve the alerts and their introduction, by making them more accessible, easy to use, not intrusive, more accurate, as well as integrated across the whole health care system; and (4) contextual factors affecting views and use of alerts in the NHS trusts. Digital alerts are more optimally used in general hospital units with a lower senior decision maker:patient ratio and by health care professionals with experience of a similar technology. Better use of the alerts was associated with quality improvement initiatives and continuous sepsis training. The trusts' features, such as the presence of a 24/7 emergency outreach team, good technological resources, and staffing and teamwork, favored a more optimal use. CONCLUSIONS: Trust implementation of sepsis or deterioration CCDSSs requires support on multiple levels and at all phases of the intervention, starting from a prego-live analysis addressing organizational needs and readiness. Advancements toward minimally disruptive and smart digital alerts as sepsis or deterioration CCDSSs, which are more accurate and specific but at the same time scalable and accessible, require policy changes and investments in multidisciplinary research.
背景:脓毒症是导致严重疾病和死亡的常见原因。脓毒症的管理仍然具有挑战性且不尽如人意。为了支持快速脓毒症诊断和治疗,筛选工具已嵌入医院数字系统中,作为数字警报出现。实施数字警报以改善脓毒症和病情恶化的管理是一项复杂的干预措施,必须与团队工作流程以及医院工作人员的观点和实践相适应。尽管在最佳实施中人类决策和行为至关重要,但很少有定性研究探讨医疗保健专业人员对脓毒症或恶化计算机化临床医生决策支持系统 (CCDSS) 的看法和经验。
目的:本研究旨在探讨医疗保健专业人员对使用脓毒症或恶化 CCDSS 的看法和经验,并确定在英国国民保健服务 (NHS) 医院实施和使用这些系统的障碍和促进因素。
方法:我们在英格兰的 3 家 NHS 医院信托基金的急诊部门、外展团队和重症监护或急症病房中,对医疗保健专业人员进行了一项定性、多地点的研究,包括非结构化观察和半结构化访谈。使用主题分析对访谈和观察数据进行了归纳分析。
结果:共对 22 名医疗保健专业人员进行了访谈,并进行了 12 次观察。确定了四个关于数字警报的主题:(1) 支持作为电子健康记录中的嵌套决策,但从不替代专业人员的知识和经验;(2) 根据上下文(如医院科室和工作角色)提醒采取行动;(3) 通过使警报更易于访问、易于使用、不具侵入性、更准确以及在整个医疗保健系统中集成来改进警报及其引入;(4) 影响 NHS 信托中警报看法和使用的上下文因素。在一般医院科室中,数字警报在具有较低高级决策者与患者比例的情况下以及在具有类似技术经验的医疗保健专业人员中得到了更优化的使用。更好地使用警报与质量改进举措和持续的脓毒症培训相关。信托的特点,如 24/7 紧急外展团队的存在、良好的技术资源以及人员配备和团队合作,有利于更优化地使用。
结论:脓毒症或恶化 CCDSS 的信托实施需要在多个层面和干预的所有阶段提供支持,从解决组织需求和准备情况的预上线分析开始。朝着更准确和更具体但同时更具可扩展性和可访问性的最小干扰和智能数字警报作为脓毒症或恶化 CCDSS 的发展,需要政策变革和对多学科研究的投资。
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