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

Area of Science:

• Healthcare Informatics
• Clinical Decision Support Systems
• Intensive Care Unit (ICU) Medicine

Background:

• Clinical decision support systems (CDSSs) are vital in healthcare for improving decision-making, particularly in ICUs.
• However, suboptimal CDSS utilization leads to alert fatigue, potentially causing patient harm.
• ICU clinicians are especially susceptible to alert desensitization.

Purpose of the Study:

• To evaluate facilitators and barriers to appropriate CDSS interaction in the ICU.
• To propose methods for enhancing current ICU CDSS.

Main Methods:

• A sequential explanatory mixed-methods study design was employed, utilizing the BEhavior and Acceptance fRamework (BEAR).
• An international survey was conducted with clinicians (pharmacists, physicians) experienced with CDSS.
• Qualitative analysis of in-depth interviews further explored clinician beliefs and behaviors regarding CDSS.

Main Results:

• A survey of 48 respondents indicated that 75% viewed responding to CDSS alerts as part of their job, yet 56.5% reported experiencing alert fatigue.
• Five facilitators were identified: patient safety, ease of response, specificity, prioritization, and feedback.
• Four barriers were identified: excessive alert quantity, challenging work environment, difficulty in response, and alert irrelevance.

Conclusions:

• Institutions must focus on specific areas to improve appropriate CDSS interaction in the ICU.
• Tailoring CDSS to the unique ICU environment is crucial for enhancing system effectiveness.
• Optimized CDSS interaction holds the potential to significantly improve patient safety outcomes.