JMIR Publications

ABSTRACT

Background:

Sepsis is a common cause of serious illness and death. Sepsis management remains challenging and sub-optimal. To support rapid sepsis diagnosis and treatment, screening tools have been embedded into hospital digital systems to appear as digital alerts. The implementation of digital alerts to improve management of sepsis/deterioration is a complex intervention which has to fit with team workflow and the views and practices of hospital staff. Despite the importance of human decision making and behaviour in optimal implementation, there are limited qualitative studies that explore the views and experiences of healthcare professionals regarding digital alerts as sepsis/deterioration computerised clinician decision support systems.

Objective:

To explore the views and experiences of healthcare professionals on the use of sepsis/deterioration computerised clinician decision support systems and to identify barriers and facilitators to their implementation and use in NHS hospitals.

Methods:

A qualitative, multi-site study with unstructured observations and semi-structured interviews with healthcare professionals from emergency departments, outreach teams and intensive/acute units in three NHS hospital Trusts in England. Data from both interviews and observations were analysed together inductively using thematic analysis.

Results:

Twenty-two healthcare professionals were interviewed, and twelve observation sessions were undertaken. Four themes were identified in relation to sepsis digital alerts: 1) Support decision-making as nested in electronic health records. Participants viewed them as useful tools in decision-making but emphasised that they did not substitute their knowledge and experience; 2) Remind to take action according to the context. Participants expressed that they served as reminders for different clinical actions depending on the hospital unit and the job role; 3) Improve the alerts and their introduction. Participants felt the alerts could be improved by being more accessible, more accurate, and that they should be integrated across the whole healthcare system; 4) Contextual factors affecting views and use of alerts in the Trusts. Digital alerts are more optimally used in general hospital units with a lower senior decision maker/patient ratio and by healthcare professionals with experience of a similar technology. Better use of the alerts was associated with quality improvement initiatives and continuous sepsis training. Trust’s features, such as the presence of a 24/7 emergency outreach team, good technological resources, staffing and teamwork, favoured a more optimal use. The easier the tool itself is to use, it is not one of many and is not intrusive, the more positively participants viewed and used it.

Conclusions:

Trust implementation of sepsis/deterioration computerised clinician decision support systems requires support on multiple levels and at all phases of the intervention – starting from a pre-go-live analysis addressing organisational needs and readiness. Advancements towards minimally disruptive and smart digital alerts as sepsis/deterioration computerised clinician decision support systems – which are more accurate and specific, but at the same time scalable and accessible – have to see policy changes and investments in multidisciplinary research. Clinical Trial: The ClinicalTrials.gov registration identifier for this study is NCT05741801; the protocol ID is 16347.