Implementation of a Digitally Enabled Care Pathway (Part 2): Qualitative Analysis of Experiences of Health Care Professionals.

Alistair Connell,Mary Emerson,Claire Nightingale,Sarah Stanley,Rosalind Raine,Cían Hughes,Geraint Rees,Alan Karthikesalingam,Trevor Back,Dominic King,Peter Martin,Christopher Laing,Georgia Black,Gareth Jones,Jennifer Cross,Hugh Montgomery,Charles Merrick,Mustafa Suleyman,Kareem Ayoub

doi:10.2196/13143

Abstract

BackgroundOne reason for the introduction of digital technologies into health care has been to try to improve safety and patient outcomes by providing real-time access to patient data and enhancing communication among health care professionals. However, the adoption of such technologies into clinical pathways has been less examined, and the impacts on users and the broader health system are poorly understood. We sought to address this by studying the impacts of introducing a digitally enabled care pathway for patients with acute kidney injury (AKI) at a tertiary referral hospital in the United Kingdom. A dedicated clinical response team—comprising existing nephrology and patient-at-risk and resuscitation teams—received AKI alerts in real time via Streams, a mobile app. Here, we present a qualitative evaluation of the experiences of users and other health care professionals whose work was affected by the implementation of the care pathway.ObjectiveThe aim of this study was to qualitatively evaluate the impact of mobile results viewing and automated alerting as part of a digitally enabled care pathway on the working practices of users and their interprofessional relationships.MethodsA total of 19 semistructured interviews were conducted with members of the AKI response team and clinicians with whom they interacted across the hospital. Interviews were analyzed using inductive and deductive thematic analysis.ResultsThe digitally enabled care pathway improved access to patient information and expedited early specialist care. Opportunities were identified for more constructive planning of end-of-life care due to the earlier detection and alerting of deterioration. However, the shift toward early detection also highlighted resource constraints and some clinical uncertainty about the value of intervening at this stage. The real-time availability of information altered communication flows within and between clinical teams and across professional groups.ConclusionsDigital technologies allow early detection of adverse events and of patients at risk of deterioration, with the potential to improve outcomes. They may also increase the efficiency of health care professionals’ working practices. However, when planning and implementing digital information innovations in health care, the following factors should also be considered: the provision of clinical training to effectively manage early detection, resources to cope with additional workload, support to manage perceived information overload, and the optimization of algorithms to minimize unnecessary alerts.

Highlights

BackgroundIn many health systems, the ageing demographic of hospital patients is accompanied by worsening health and a greater need for diverse investigations and treatments
A total of 19 semistructured interviews were conducted with members of the acute kidney injury (AKI) response team and clinicians with whom they interacted across the hospital
We present a qualitative evaluation of the experiences of users and other health care professionals whose work was affected by the implementation of the new care pathway

Summary

Introduction

BackgroundIn many health systems, the ageing demographic of hospital patients is accompanied by worsening health and a greater need for diverse investigations and treatments. Evidence suggests that patient outcomes improve where such clinical decline is detected and acted upon early, and substantial effort has been made worldwide in this regard, for instance, through the use of track and trigger scoring systems to detect decline [3] or the provision of emergency response teams [4,5]. Such changes have not been matched by other key components of care delivery: the manner in which health care teams communicate and the manner in which data are accessed and presented. We present a qualitative evaluation of the experiences of users and other health care professionals whose work was affected by the implementation of the care pathway

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