JMIR Publications

ABSTRACT

Background:

Patients who require intensive care unit (ICU) level of care frequently develop hospital-acquired functional decline, a new or worsening loss of ability to perform self-care activities that is associated with prolonged periods in immobility. This morbidity may persist for months to years after hospitalization and is potentially preventable through initiating mobility interventions in the ICU using a multidisciplinary, evidence-based intervention to maintain functional status. While guidelines for ICU patients' physical activity exist, timely identification of patients suitable for activity interventions is an ongoing challenge due to the dynamic nature of critical illness and the number of locations in the electronic health record (EHR) that clinicians need to click in and out of to synthesize patient data. There is, therefore, a critical need to develop an effective knowledge-based clinical decision support system (CDSS) interface in the EHR for efficient identification of patients appropriate for physical activity interventions and coordination of patient-specific activity plans within the ICU team.

Objective:

The objective of this two-phase project is to develop a CDSS interface for consistent translation of patient-specific data to inform evidence-based physical activity interventions delivered by registered nurses and physical therapists for ICU settings, and evaluate its usability, usefulness, cognitive workload, acceptability, feasibility, and effectiveness on decision-making outcomes.

Methods:

In Phase 1, we will develop a useable, useful, and acceptable CDSS prototype by conducting clinician interviews using well-known methods in a novel sequence; we will use a user-centered design approach and identify clinical workflow considerations, potential barriers, and implementation strategies using an implementation science approach. In Phase 2, we will evaluate the CDSS usability, cognitive workload, acceptability, and effectiveness for activity guideline adoption in adequately powered trials, 1) virtually in a simulated EHR environment and, 2) in two ICU units in one tertiary care hospital.

Results:

The CDSS development phase is expected to conclude by December 2025. Data collection and analysis of the CDSS evaluation are expected to conclude by December 2028.

Conclusions:

We expect the results of this multi-method process for designing, testing efficacy and identifying barriers to real world use to have an important positive impact on others who seek to develop safe and effective CDSS that aligns with clinical workflow. Importantly, this work completes the necessary pilot study for a subsequent multi-site pragmatic clinical trial to scale the concurrent use of patient data with guideline recommendations at the point of care to deliver evidence-based interventions to reduce hospital-acquired functional decline at its negative, costly outcomes.