Abstract
BackgroundClinicians often disregard potentially beneficial clinical decision support (CDS).ObjectiveIn this study, we sought to explore the psychological and behavioral barriers to the use of a CDS tool.MethodsWe conducted a qualitative study involving emergency medicine physicians and physician assistants. A semistructured interview guide was created based on the Capability, Opportunity, and Motivation-Behavior model. Interviews focused on the barriers to the use of a CDS tool built based on Wells’ criteria for pulmonary embolism to assist clinicians in establishing pretest probability of pulmonary embolism before imaging.ResultsInterviews were conducted with 12 clinicians. Six barriers were identified, including (1) Bayesian reasoning, (2) fear of missing a pulmonary embolism, (3) time pressure or cognitive load, (4) gestalt includes Wells’ criteria, (5) missed risk factors, and (6) social pressure.ConclusionsClinicians highlighted several important psychological and behavioral barriers to CDS use. Addressing these barriers will be paramount in developing CDS that can meet its potential to transform clinical care.
Highlights
Clinicians often disregard potentially beneficial clinical decision support (CDS) tools. Extensive study of these tools has shown that their use is associated with a morbidity reduction of 10% to 18%, placing CDS at the top of the spectrum of quality improvement interventions [1]
Systematic reviews have shown that the use of these criteria decreases ordering of computed tomography (CT) scans by 25% without resulting in additional missed pulmonary emboli (PEs) by clinicians [12]
“A lot of people say that I'd rather order 10 extra CTs than miss 1 pulmonary embolism pulmonary embolism rule-out criteria (PERC) (PE)...There is a culture of fear of missing.”
Summary
Clinicians often disregard potentially beneficial clinical decision support (CDS) tools. Extensive study of these tools has shown that their use is associated with a morbidity reduction of 10% to 18%, placing CDS at the top of the spectrum of quality improvement interventions [1]. Improvements in quality of care observed with CDS use [2,3,4,5,6,7,8] have been significantly limited by consistently low clinician adoption, estimated at 10% [9,10]. Clinicians have requested the removal of CDS tools based on these criteria, even when local efficacy has been demonstrated [13]. Clinicians often disregard potentially beneficial clinical decision support (CDS)
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