Abstract: FR-PO072
Implementation of Clinical Decision Support for AKI: Mixed-Methods Evaluation of Healthcare Providers' Perceptions and Experiences
Session Information
- AKI: Clinical Outcomes, Trials
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Bhatt, Meha, University of Calgary, Calgary, Alberta, Canada
- Finlay, Juli, University of Calgary, Calgary, Alberta, Canada
- Howarth, Megan, University of Calgary, Calgary, Alberta, Canada
- Benterud, Eleanor C., University of Calgary, Calgary, Alberta, Canada
- Pannu, Neesh I., University of Alberta, Edmonton, Alberta, Canada
- James, Matthew T., University of Calgary, Calgary, Alberta, Canada
Background
Clinical decision support (CDS) initiatives can be effective strategies for enhancing healthcare delivery and improving patient outcomes. However, such interventions for acute kidney injury (AKI) have reported variable effectiveness. Involvement of end-users in the development and implementation may help optimize accessibility and uptake of CDS systems for AKI. Evaluation of healthcare providers' experiences can inform the process.
Methods
We used a multi-phase approach involving healthcare providers, decision-makers, and implementation science experts to deploy an electronic CDS system on surgery units in Calgary, Alberta. The system consisted of: AKI stage alerts, Adverse medication alerts, AKI clinical summary display, and AKI order set. Implementation included usability testing of tools, co-development of tailored strategies for using the tools, education programs for staff, and audit and feedback of AKI quality indicators. The perceptions and experiences of end-users were evaluated using surveys and interviews; the latter were analyzed using a qualitative descriptive approach.
Results
During the initial 12 month post-implementation period, 318 AKI alerts and 48 adverse medication alerts were generated on the units. 104 clinical end-users have completed surveys and 10 have participated in interviews. Overall 88% of physicians and 98% of nursing staff stated it was important to improve AKI care on their hospital units. There was variable uptake of the specific tools with interview responses indicating that the AKI stage alerts and flagged medications were most valuable for the users. Interviews identified themes related to CDS implementation; 1) culture of increased AKI awareness, 2) credibility around communicating about AKI within an interdisciplinary team, 3) system barriers for recognition and timely AKI management.
Conclusion
End-user engagement in the process of developing and implementing CDS tools for AKI can enhance the acceptability and perceived value of tools by care providers outside the discipline of nephrology. Further strategies may be needed to address system-wide barriers to early management for AKI and to evaluate whether this degree of intensive end-user engagement enhances the impact of CDS interventions on processes of care and outcomes of AKI.