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Implementation and clinical utility of a Computer-Aided Risk Score for Mortality (CARM): a qualitative study
OBJECTIVES: The Computer-Aided Risk Score for Mortality (CARM) estimates the risk of in-hospital mortality following acute admission to the hospital by automatically amalgamating physiological measures, blood tests, gender, age and COVID-19 status. Our aims were to implement the score with a small g...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BMJ Publishing Group
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9853152/ https://www.ncbi.nlm.nih.gov/pubmed/36653055 http://dx.doi.org/10.1136/bmjopen-2022-061298 |
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author | Dyson, Judith McCrorie, Carolyn Benn, Jonathan Richardson, Donald Marsh, Claire Bowskill, Gill Double, Keith Gallagher, Jean Faisal, Muhammad Mohammed, Mohammed A |
author_facet | Dyson, Judith McCrorie, Carolyn Benn, Jonathan Richardson, Donald Marsh, Claire Bowskill, Gill Double, Keith Gallagher, Jean Faisal, Muhammad Mohammed, Mohammed A |
author_sort | Dyson, Judith |
collection | PubMed |
description | OBJECTIVES: The Computer-Aided Risk Score for Mortality (CARM) estimates the risk of in-hospital mortality following acute admission to the hospital by automatically amalgamating physiological measures, blood tests, gender, age and COVID-19 status. Our aims were to implement the score with a small group of practitioners and understand their first-hand experience of interacting with the score in situ. DESIGN: Pilot implementation evaluation study involving qualitative interviews. SETTING: This study was conducted in one of the two National Health Service hospital trusts in the North of England in which the score was developed. PARTICIPANTS: Medical, older person and ICU/anaesthetic consultants and specialist grade registrars (n=116) and critical outreach nurses (n=7) were given access to CARM. Nine interviews were conducted in total, with eight doctors and one critical care outreach nurse. INTERVENTIONS: Participants were given access to the CARM score, visible after login to the patients’ electronic record, along with information about the development and intended use of the score. RESULTS: Four themes and 14 subthemes emerged from reflexive thematic analysis: (1) current use (including support or challenge clinical judgement and decision making, communicating risk of mortality and professional curiosity); (2) barriers and facilitators to use (including litigation, resource needs, perception of the evidence base, strengths and limitations), (3) implementation support needs (including roll-out and integration, access, training and education); and (4) recommendations for development (including presentation and functionality and potential additional data). Barriers and facilitators to use, and recommendations for development featured highly across most interviews. CONCLUSION: Our in situ evaluation of the pilot implementation of CARM demonstrated its scope in supporting clinical decision making and communicating risk of mortality between clinical colleagues and with service users. It suggested to us barriers to implementation of the score. Our findings may support those seeking to develop, implement or improve the adoption of risk scores. |
format | Online Article Text |
id | pubmed-9853152 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-98531522023-01-21 Implementation and clinical utility of a Computer-Aided Risk Score for Mortality (CARM): a qualitative study Dyson, Judith McCrorie, Carolyn Benn, Jonathan Richardson, Donald Marsh, Claire Bowskill, Gill Double, Keith Gallagher, Jean Faisal, Muhammad Mohammed, Mohammed A BMJ Open Qualitative Research OBJECTIVES: The Computer-Aided Risk Score for Mortality (CARM) estimates the risk of in-hospital mortality following acute admission to the hospital by automatically amalgamating physiological measures, blood tests, gender, age and COVID-19 status. Our aims were to implement the score with a small group of practitioners and understand their first-hand experience of interacting with the score in situ. DESIGN: Pilot implementation evaluation study involving qualitative interviews. SETTING: This study was conducted in one of the two National Health Service hospital trusts in the North of England in which the score was developed. PARTICIPANTS: Medical, older person and ICU/anaesthetic consultants and specialist grade registrars (n=116) and critical outreach nurses (n=7) were given access to CARM. Nine interviews were conducted in total, with eight doctors and one critical care outreach nurse. INTERVENTIONS: Participants were given access to the CARM score, visible after login to the patients’ electronic record, along with information about the development and intended use of the score. RESULTS: Four themes and 14 subthemes emerged from reflexive thematic analysis: (1) current use (including support or challenge clinical judgement and decision making, communicating risk of mortality and professional curiosity); (2) barriers and facilitators to use (including litigation, resource needs, perception of the evidence base, strengths and limitations), (3) implementation support needs (including roll-out and integration, access, training and education); and (4) recommendations for development (including presentation and functionality and potential additional data). Barriers and facilitators to use, and recommendations for development featured highly across most interviews. CONCLUSION: Our in situ evaluation of the pilot implementation of CARM demonstrated its scope in supporting clinical decision making and communicating risk of mortality between clinical colleagues and with service users. It suggested to us barriers to implementation of the score. Our findings may support those seeking to develop, implement or improve the adoption of risk scores. BMJ Publishing Group 2023-01-17 /pmc/articles/PMC9853152/ /pubmed/36653055 http://dx.doi.org/10.1136/bmjopen-2022-061298 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Qualitative Research Dyson, Judith McCrorie, Carolyn Benn, Jonathan Richardson, Donald Marsh, Claire Bowskill, Gill Double, Keith Gallagher, Jean Faisal, Muhammad Mohammed, Mohammed A Implementation and clinical utility of a Computer-Aided Risk Score for Mortality (CARM): a qualitative study |
title | Implementation and clinical utility of a Computer-Aided Risk Score for Mortality (CARM): a qualitative study |
title_full | Implementation and clinical utility of a Computer-Aided Risk Score for Mortality (CARM): a qualitative study |
title_fullStr | Implementation and clinical utility of a Computer-Aided Risk Score for Mortality (CARM): a qualitative study |
title_full_unstemmed | Implementation and clinical utility of a Computer-Aided Risk Score for Mortality (CARM): a qualitative study |
title_short | Implementation and clinical utility of a Computer-Aided Risk Score for Mortality (CARM): a qualitative study |
title_sort | implementation and clinical utility of a computer-aided risk score for mortality (carm): a qualitative study |
topic | Qualitative Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9853152/ https://www.ncbi.nlm.nih.gov/pubmed/36653055 http://dx.doi.org/10.1136/bmjopen-2022-061298 |
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