Identifying Barriers to The Implementation of Communicating Narrative Concerns Entered by Registered Nurses, An Early Warning System SmartApp

IF 2.1 2区医学 Q4 MEDICAL INFORMATICS

Applied Clinical Informatics Pub Date : 2024-04-17 DOI:10.1055/s-0044-1785688

Mollie Hobensack, Jennifer Withall, Brian Douthit, Kenrick Cato, Patricia Dykes, Sandy Cho, Graham Lowenthal, Catherine Ivory, Po-Yin Yen, Sarah Rossetti

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Abstract

Background Nurses are at the frontline of detecting patient deterioration. We developed Communicating Narrative Concerns Entered by Registered Nurses (CONCERN), an early warning system for clinical deterioration that generates a risk prediction score utilizing nursing data. CONCERN was implemented as a randomized clinical trial at two health systems in the Northeastern United States. Following the implementation of CONCERN, our team sought to develop the CONCERN Implementation Toolkit to enable other hospital systems to adopt CONCERN.

Objective The aim of this study was to identify the optimal resources needed to implement CONCERN and package these resources into the CONCERN Implementation Toolkit to enable the spread of CONCERN to other hospital sites.

Methods To accomplish this aim, we conducted qualitative interviews with nurses, prescribing providers, and information technology experts in two health systems. We recruited participants from July 2022 to January 2023. We conducted thematic analysis guided by the Donabedian model. Based on the results of the thematic analysis, we updated the α version of the CONCERN Implementation Toolkit.

Results There was a total of 32 participants included in our study. In total, 12 themes were identified, with four themes mapping to each domain in Donabedian's model (i.e., structure, process, and outcome). Eight new resources were added to the CONCERN Implementation Toolkit.

Conclusions This study validated the α version of the CONCERN Implementation Toolkit. Future studies will focus on returning the results of the Toolkit to the hospital sites to validate the β version of the CONCERN Implementation Toolkit. As the development of early warning systems continues to increase and clinician workflows evolve, the results of this study will provide considerations for research teams interested in implementing early warning systems in the acute care setting.

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识别实施 "交流注册护士输入的关切叙事"（一种预警系统智能应用程序）的障碍

背景护士处于发现病人病情恶化的第一线。我们开发了由注册护士输入的 "沟通叙事关注点"（CONCERN），这是一种临床病情恶化预警系统，可利用护理数据生成风险预测评分。CONCERN 作为一项随机临床试验在美国东北部的两个医疗系统中实施。CONCERN 实施后，我们的团队试图开发 CONCERN 实施工具包，以便其他医院系统也能采用 CONCERN。目标本研究旨在确定实施 CONCERN 所需的最佳资源，并将这些资源打包到 CONCERN 实施工具包中，以便将 CONCERN 推广到其他医院。方法为了实现这一目标，我们对两个医疗系统的护士、处方提供者和信息技术专家进行了定性访谈。我们在 2022 年 7 月至 2023 年 1 月期间招募了参与者。我们在多纳比德模型的指导下进行了主题分析。根据主题分析的结果，我们更新了 CONCERN 实施工具包的 α 版本。结果共有 32 名参与者参与了我们的研究。总共确定了 12 个主题，其中 4 个主题与 Donabedian 模型中的每个领域（即结构、过程和结果）相对应。CONCERN 实施工具包中新增了八项资源。结论本研究验证了 CONCERN 实施工具包的 α 版本。今后的研究将侧重于将工具包的结果返回到医院现场，以验证 β 版本的 CONCERN 实施工具包。随着早期预警系统的不断发展和临床医生工作流程的演变，本研究的结果将为有兴趣在急症护理环境中实施早期预警系统的研究团队提供参考。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Applied Clinical Informatics MEDICAL INFORMATICS-

CiteScore

4.60

自引率

24.10%

发文量

132

期刊介绍： ACI is the third Schattauer journal dealing with biomedical and health informatics. It perfectly complements our other journals Öffnet internen Link im aktuellen FensterMethods of Information in Medicine and the Öffnet internen Link im aktuellen FensterYearbook of Medical Informatics. The Yearbook of Medical Informatics being the “Milestone” or state-of-the-art journal and Methods of Information in Medicine being the “Science and Research” journal of IMIA, ACI intends to be the “Practical” journal of IMIA.