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. 2023 Aug 25;5(9):e0967.
doi: 10.1097/CCE.0000000000000967. eCollection 2023 Sep.

Facilitators and Barriers to Interacting With Clinical Decision Support in the ICU: A Mixed-Methods Approach

Adrian Wong  1 , Lucas A Berenbrok  2 , Lauren Snader  2 , Yu Hyeon Soh  2 , Vishakha K Kumar  3 , Muhammad Ali Javed  4 , David W Bates  5   6 , Lauren R Sorce  7   8 , Sandra L Kane-Gill  2
Affiliations

Facilitators and Barriers to Interacting With Clinical Decision Support in the ICU: A Mixed-Methods Approach

Adrian Wong et al. Crit Care Explor. .

Abstract

Objectives: 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.

Design: Sequential explanatory mixed-methods study design, using the BEhavior and Acceptance fRamework.

Setting: International survey study.

Patient/subjects: Clinicians (pharmacists, physicians) identified via survey, with recent experience with clinical decision support.

Interventions: 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.

Measurements and main results: 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.

Conclusions: 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.

Keywords: alert fatigue; clinical decision support systems; implementation science; intensive care unit; patient safety.

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Conflict of interest statement

Dr. Bates reports grants and personal fees from EarlySense, personal fees from Center for Digital Innovation Negev, equity from ValeraHealth, equity from Clew, equity from MDClone, personal fees and equity from AESOP, personal fees and equity from Feelbetter, equity from Guided Clinical Solutions, and grants from International Business Machines Corporation Watson Health, outside the submitted work. Dr. Bates has a patent pending (PHC-028564 US Patent Cooperation Treaty), on intraoperative clinical decision support. Dr. Kane-Gill receives grant funding from the National Institute of Diabetes and Digestive and Kidney Diseases R01DK121730 and U01DK130010, the National Center for Complementary and Integrative Health U54AT008909, and the Jewish Healthcare Foundation. Drs. Sorce and Kane-Gill also hold executive positions in the Society of Critical Care Medicine. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Overview of study design. CPP = Clinical Pharmacology and Pharmacy, SCCM = Society of Critical Care Medicine, TDF = Theoretical Domains Framework.
See this image and copyright information in PMC

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