RT Journal Article
SR Electronic
T1 Implementation and clinical utility of a Computer-Aided Risk Score for Mortality (CARM): a qualitative study
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e061298
DO 10.1136/bmjopen-2022-061298
VO 13
IS 1
A1 Judith Dyson
A1 Carolyn McCrorie
A1 Jonathan Benn
A1 Donald Richardson
A1 Claire Marsh
A1 Gill Bowskill
A1 Keith Double
A1 Jean Gallagher
A1 Muhammad Faisal
A1 Mohammed A Mohammed
YR 2023
UL http://bmjopen.bmj.com/content/13/1/e061298.abstract
AB 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.Data are available upon reasonable request. For access to data, interested parties may contact Judith.Dyson@bcu.ac.uk.