Clinical Decision Support in the PICU: Implications for Design and Evaluation

Area of Science:

• Pediatric critical care medicine
• Health informatics
• Clinical decision support systems

Background:

• Clinical decision support (CDS) tools are increasingly integrated into Pediatric Intensive Care Units (PICUs).
• Understanding the current landscape and provider perceptions of these tools is crucial for optimizing their use and impact.

Purpose of the Study:

• To assess the current utilization and perceptions of clinical decision support (CDS) tools within PICUs.
• To identify priority areas for future research and development in this field.

Main Methods:

• A quantitative, international, cross-sectional survey was conducted.
• The survey targeted medical directors, nurses, physicians, and advanced practice providers in PICUs affiliated with the Pediatric Acute Lung Injury and Sepsis Network.
• Data were collected via a role-specific, web-based survey in November-December 2020.

Main Results:

• 109 respondents from 45 institutions participated, predominantly attending physicians from US university-affiliated PICUs.
• The most utilized CDS tools were people-based resources (93%) and laboratory result highlighting (86%).
• Providers prioritized patient safety impact and evidence base for CDS, but expressed concerns about diminished critical thinking and workflow disruption. Routine assessment of CDS impact was infrequent.

Conclusions:

• While consensus exists on the importance of evidence-based CDS for patient safety, practitioners perceive current tools as intrusive and potentially detrimental to critical thinking.
• There is a need to deimplement ineffective CDS and improve post-implementation evaluation to mitigate provider burden.
• Priority research areas include optimizing CDS to enhance, not hinder, clinical judgment and workflow.