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 gr...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-01-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/1/e061298.full |
| _version_ | 1797950634872274944 |
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| author | Muhammad Faisal Donald Richardson Judith Dyson Claire Marsh Mohammed A Mohammed Jonathan Benn Jean Gallagher Carolyn McCrorie Gill Bowskill Keith Double |
| author_facet | Muhammad Faisal Donald Richardson Judith Dyson Claire Marsh Mohammed A Mohammed Jonathan Benn Jean Gallagher Carolyn McCrorie Gill Bowskill Keith Double |
| author_sort | Muhammad Faisal |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-04-10T22:18:14Z |
| format | Article |
| id | doaj.art-12fd652bddc641c9b30b39b92e4dceee |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-04-10T22:18:14Z |
| publishDate | 2023-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-12fd652bddc641c9b30b39b92e4dceee2023-01-18T05:30:10ZengBMJ Publishing GroupBMJ Open2044-60552023-01-0113110.1136/bmjopen-2022-061298Implementation and clinical utility of a Computer-Aided Risk Score for Mortality (CARM): a qualitative studyMuhammad Faisal0Donald Richardson1Judith Dyson2Claire Marsh3Mohammed A Mohammed4Jonathan Benn5Jean Gallagher6Carolyn McCrorie7Gill Bowskill8Keith Double9Faculty of Health Studies, University of Bradford, Bradford, UKDepartment of Renal Medicine, York Teaching Hospital NHS Foundation Trust, York, UK8 School of Health and Social Work, University Of Hull, Hull, UK1 Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UKStrategy Unit, NHS Midlands and Lancashire Commissioning Support Unit, West Bromwich, UK1University of Leeds, UK1 Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK1Leeds Institute of Health Sciences, University of Leeds, Leeds, UKService User and Carer Research Group, Faculty of Health Studies, University of Bradford, Bradford, UKService User and Carer Research Group, Faculty of Health Studies, University of Bradford, Bradford, UKObjectives 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.https://bmjopen.bmj.com/content/13/1/e061298.full |
| spellingShingle | Muhammad Faisal Donald Richardson Judith Dyson Claire Marsh Mohammed A Mohammed Jonathan Benn Jean Gallagher Carolyn McCrorie Gill Bowskill Keith Double Implementation and clinical utility of a Computer-Aided Risk Score for Mortality (CARM): a qualitative study BMJ Open |
| 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 |
| url | https://bmjopen.bmj.com/content/13/1/e061298.full |
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