Informing the design of clinical decision support services for evaluation of children with minor blunt head trauma in the emergency department: A sociotechnical analysis

Sheehan, Barbara; Nigrovic, Lise E.; Dayan, Peter; Kuppermann, Nathan; Ballard, Dustin; Alessandrini, Evaline A.; Bajaj, Lalit; Goldberg, Howard; Hoffman, Jeffrey; Offerman, Steven R.; Mark, Dustin G.; Swietlik, Marguerite; Tham, Eric; Tzimenatos, Leah; Vinson, David R.; Jones, Grant S.; Bakken, Suzanne

doi:10.1016/j.jbi.2013.07.005

Cited by 64 publications

(63 citation statements)

References 27 publications

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“…It was noted that multiple nomenclatures were used to describe CDSS, such as clinical decision support system, 11,19-25 clinical information system, 3 computerbased decision support, 26 computerized decision support system, 27 computerized care plan, 28 computerized protocol, 29 computerized clinical guidelines and protocols, 30 clinical reminder system, 31 and clinical decision support services. 32 For the purpose of this study, only the term clinical decision support system was used in order to avoid confusion of names. The CDSSs studied were designed to support a wide range of decisions such as diagnosis and nursing care plan, 28 clinical practice guidelines 26,30 or protocols, 29 diagnosis and treatments, 3,11,[19][20][21][22][23][24][25]32 rehabilitation, 27 and reminder systems.…”

Section: Quality Appraisalmentioning

confidence: 99%

“…32 For the purpose of this study, only the term clinical decision support system was used in order to avoid confusion of names. The CDSSs studied were designed to support a wide range of decisions such as diagnosis and nursing care plan, 28 clinical practice guidelines 26,30 or protocols, 29 diagnosis and treatments, 3,11,[19][20][21][22][23][24][25]32 rehabilitation, 27 and reminder systems. 31 Twelve of the 16 studies were conducted in Western countries (the United States, the United Kingdom, the Netherlands, Spain, and Australia).…”

Section: Quality Appraisalmentioning

confidence: 99%

“…Four of the studies were carried out in Taiwan. The study populations were sampled from various types of settings such as the regional healthcare system, 26 hospitals, 19,25,[28][29][30][31][32] medical centers, 21 primary care, 3,22,24 and clinics. 11,20,23,27 Two of the studies examined the same population and setting but with different study emphases 11,20 : one targeted its research on how an organization affected the adoption of CDSS, 20 whereas the other looked into the overall factors affecting adoption of CDSS by nurses.…”

Section: Quality Appraisalmentioning

confidence: 99%

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A Critical Review of the Theoretical Frameworks and the Conceptual Factors in the Adoption of Clinical Decision Support Systems

Khong

Holroyd

Wang

2015

CIN: Computers, Informatics, Nursing

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The clinical decision support system is utilized to translate knowledge into evidence-based practice in clinical settings. Many studies have been conducted to understand users' adoption of the clinical decision support system. A critical review was conducted to understand the theoretical or conceptual frameworks used to inform the studies on the adoption of the clinical decision support system. The review identified 15 theoretical and conceptual frameworks using multiple hybrids of theories and concepts. The Technology Acceptance Model was the most frequently used baseline framework combined with frameworks such as the diffusion of innovation, social theory, longitudinal theory, and so on. The results from these articles yielded multiple concepts influencing the adoption of the clinical decision support system. These concepts can be recategorized into nine major concepts, namely, the information system, person (user or patient), social, organization, perceived benefits, emotions, trustability, relevance (fitness), and professionalism. None of the studies found all the nine concepts. That said, most of them have identified the information system, organization, and person concepts as three of its concepts affecting the use of the clinical decision support system. Within each of the concepts, its subconcepts were noted to be very varied. Yet each of these subconcepts has significantly contributed toward the different facets of the concepts. A pluralistic framework was built using the concepts and subconcepts to provide an overall framework construct for future study on the adoption of the clinical decision support system.

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Section: Quality Appraisalmentioning

confidence: 99%

Section: Quality Appraisalmentioning

confidence: 99%

Section: Quality Appraisalmentioning

confidence: 99%

See 1 more Smart Citation

A Critical Review of the Theoretical Frameworks and the Conceptual Factors in the Adoption of Clinical Decision Support Systems

Khong

Holroyd

Wang

2015

CIN: Computers, Informatics, Nursing

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“…Once validated, translation of this rule into practice will be necessary. Knowledge translation for implementation of pediatric traumatic brain injury prediction rules is currently being studied, 25 and application of the abdominal CT rule could follow similar methods.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Clinician Suspicion Versus a Clinical Prediction Rule in Identifying Children at Risk for Intra‐abdominal Injuries After Blunt Torso Trauma

Mahajan

Kuppermann

Tunik

et al. 2015

Academic Emergency Medicine

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Objectives: Emergency department (ED) identification and radiographic evaluation of children with intra-abdominal injuries who need acute intervention can be challenging. To date, it is unclear if a clinical prediction rule is superior to unstructured clinician judgment in identifying these children. The objective of this study was to compare the test characteristics of clinician suspicion with a derived clinical prediction rule to identify children at risk of intra-abdominal injuries undergoing acute intervention following blunt torso trauma.Methods: This was a planned subanalysis of a prospective, multicenter observational study of children (<18 years old) with blunt torso trauma conducted in 20 EDs in the Pediatric Emergency Care Applied Research Network (PECARN). Clinicians documented their suspicion for the presence of intra-abdominal injuries needing acute intervention as <1, 1 to 5, 6 to 10, 11 to 50, or >50% prior to knowledge of abdominal computed tomography (CT) scanning (if performed). Intra-abdominal injuries undergoing acute intervention were defined by a therapeutic laparotomy, angiographic embolization, blood transfusion for abdominal hemorrhage, or intravenous fluid administration for 2 or more days in those with pancreatic or gastrointestinal injuries. Patients were considered to be positive for clinician suspicion if suspicion was documented as ≥1%. Suspicion ≥ 1% was compared to the presence of any variable in the prediction rule for identifying children with intra-abdominal injuries undergoing acute intervention.

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“…[8][9][10][11] However, effectiveness of this approach outside of a clinical trial and generalizability across to other indications and settings is not as clear. Barriers to adoption of such a system have also been noted, 8,[12][13][14] and still need to be addressed. Specifically, disruption to physician workflow, 8,13,14 potential reduction in physician autonomy, uncertainty over optimal timing of decision support, and physician belief that their decision-making or clinical gestalt alone is appropriate or superior have been cited as barriers against adoption and acceptance.…”

mentioning

confidence: 99%

To Test or Not to Test … Decision Analysis of Decision Support

Courtney

Mills

Marin

2015

Academic Emergency Medicine

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Informing the design of clinical decision support services for evaluation of children with minor blunt head trauma in the emergency department: A sociotechnical analysis

Cited by 64 publications

References 27 publications

A Critical Review of the Theoretical Frameworks and the Conceptual Factors in the Adoption of Clinical Decision Support Systems

A Critical Review of the Theoretical Frameworks and the Conceptual Factors in the Adoption of Clinical Decision Support Systems

Comparison of Clinician Suspicion Versus a Clinical Prediction Rule in Identifying Children at Risk for Intra‐abdominal Injuries After Blunt Torso Trauma

To Test or Not to Test … Decision Analysis of Decision Support

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