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Implementation and clinical utility of a Computer-Aided Risk Score for Mortality (CARM): a qualitative study.

Judith Dyson1, Carolyn McCrorie2, Jonathan Benn3

  • 1C-SCHaRR, Birmingham City University, Birmingham, UK Judith.Dyson@bcu.ac.uk.

BMJ Open
|January 18, 2023
PubMed
Summary

The Computer-Aided Risk Score for Mortality (CARM) helps clinicians assess patient mortality risk. This pilot study identified key facilitators and barriers to its in-situ implementation and use in clinical practice.

Keywords:
intensive & critical careinternal medicinequalitative research

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Area of Science:

  • Clinical informatics
  • Health services research
  • Medical decision support

Background:

  • The Computer-Aided Risk Score for Mortality (CARM) is a tool designed to estimate in-hospital mortality risk.
  • CARM integrates physiological measures, laboratory results, demographics, and COVID-19 status for comprehensive risk assessment.

Purpose of the Study:

  • To evaluate the in-situ implementation of the CARM score.
  • To understand healthcare practitioners' first-hand experiences with the CARM score.

Main Methods:

  • A pilot implementation evaluation study was conducted.
  • Qualitative interviews were performed with clinicians (doctors and nurses) who had access to the CARM score.

Main Results:

  • Reflexive thematic analysis identified four key themes: current use, barriers and facilitators to use, implementation support needs, and recommendations for development.
  • Barriers and facilitators to use, and recommendations for development were prominent in the interviews.
  • The CARM score showed potential in supporting clinical decision-making and communicating mortality risk.

Conclusions:

  • The in-situ evaluation of CARM highlighted its utility in clinical decision support and risk communication.
  • The study identified significant barriers and facilitators impacting the score's implementation.
  • Findings offer insights for developing, implementing, and improving the adoption of clinical risk scores.