JMIR Publications

ABSTRACT

Background:

One reason for the introduction of digital technologies into healthcare has been to try to improve safety and patient outcomes by providing real time access to patient data and enhancing communication between healthcare professionals. However, the adoption of such technologies into clinical pathways has been little examined, and impacts on users and the broader health system are poorly understood. We sought to address this by studying the impacts of introducing a digitally-enabled care pathway for patients with Acute Kidney Injury (AKI) at a tertiary referral hospital in the United Kingdom. A dedicated clinical response team - comprising existing nephrology and ‘patient-at-risk and resuscitation’ teams - received AKI alerts in real time via Streams, a mobile application deployed on smartphones. Here we present a qualitative exploration of the experiences of users and other healthcare professionals whose work was affected by implementation of the care pathway.

Objective:

To characterise the impacts of mobile results viewing and automated alerting as part of a digitally-enabled care pathway on the working practices of users and on their interprofessional relationships.

Methods:

Nineteen semi-structured interviews were carried out with members of the AKI response team and clinicians with whom they interacted across the hospital. Interviews were analysed using inductive and deductive thematic analysis.

Results:

The digitally enabled care pathway improved access to patient information and expedited early specialist care. Opportunities were identified for more constructive planning of end of life care due to the earlier detection and alerting of deterioration. However, the shift towards earlier detection also highlighted resource constraints and some clinical uncertainty about the value of intervening at this stage. The real-time availability of information altered communication flows within and between clinical teams, and across professional groups.

Conclusions:

Digital technologies allow earlier detection of adverse events and of patients at risk of deterioration, with the potential to improve outcomes. They may also increase the efficiency of healthcare professionals’ working practices. However, when planning and implementing digital information innovations in healthcare, the following factors should also be considered: the provision of clinical training to effectively manage early detection; resources to cope with additional workload, support to manage perceived information overload and the optimisation of algorithms to minimise unnecessary alerts.