Computerized clinical decision support for the early recognition and management of acute kidney injury: a qualitative evaluation of end-user experience
Computerized clinical decision support for the early recognition and management of acute kidney injury: a qualitative evaluation of end-user experience
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DOI：
10.1093/ckj/sfv130
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发表时间：
2016-02-01
影响因子：
4.6
通讯作者：
Sheerin, Neil S.
中科院分区：
文献类型：
--
作者：
Kanagasundaram, Nigel S.;Bevan, Mark T.;Sheerin, Neil S.
工作背景：尽管计算机化临床决策支持（CCDS）治疗急性肾损伤（阿基）的疗效尚不清楚，但更广泛的文献包括可接受性有限和获益不明确的示例。我们的单中心研究旨在确定促进或抑制住院阿基患者使用CCDS的因素。方法：针对医疗用户，血清肌酐升高>= 25 μ mol/L/d触发CCDS，并与指导和测试顺序相关。通过回顾性访谈评估用户体验，并根据规范化过程理论进行分析。最初的试点病房经验允许工具完善。在所有成人，非重症监护病房的CCDS激活后继续进行评估。结果：24次访谈达到了主题饱和。许多受训者认为，警报可能有助于促进早期临床再评估。高级工作人员对此持怀疑态度，往往认为这是一种障碍。由于工作流程中断，“弹出窗口”和警报解除前的强制参与普遍不受欢迎。用户被驱动关闭警报尽快审查历史肌酐，并继续与预期的workflow.Conclusions：我们的研究揭示了类似的主题，以前描述的非AKI设置。侵入工作流程的系统，特别是涉及复杂互动的系统，即使对护理产生了积极影响，也可能是不可持续的。阿基CCDS的侵入性和临床益处之间的最佳平衡需要进一步评估。
Background: Although the efficacy of computerized clinical decision support (CCDS) for acute kidney injury (AKI) remains unclear, the wider literature includes examples of limited acceptability and equivocal benefit. Our single-centre study aimed to identify factors promoting or inhibiting use of in-patient AKI CCDS.Methods: Targeting medical users, CCDS triggered with a serum creatinine rise of >= 25 mu mol/L/day and linked to guidance and test ordering. User experience was evaluated through retrospective interviews, conducted and analysed according to Normalization Process Theory. Initial pilot ward experience allowed tool refinement. Assessments continued following CCDS activation across all adult, non-critical care wards.Results: Thematic saturation was achieved with 24 interviews. The alert was accepted as a potentially useful prompt to early clinical re-assessment by many trainees. Senior staff were more sceptical, tending to view it as a hindrance. 'Pop-ups' and mandated engagement before alert dismissal were universally unpopular due to workflow disruption. Users were driven to close out of the alert as soon as possible to review historical creatinines and to continue with the intended workflow.Conclusions: Our study revealed themes similar to those previously described in non-AKI settings. Systems intruding on workflow, particularly involving complex interactions, may be unsustainable even if there has been a positive impact on care. The optimal balance between intrusion and clinical benefit of AKI CCDS requires further evaluation.