TY - JOUR
T1 - Falls and delirium in older inpatients: Work-as-imagined, work-as-done and preferences for clinical decision support systems
AU - Damoiseaux-Volman, Birgit A.
AU - Medlock, Stephanie
AU - van der Eijk, Marsha D.
AU - Romijn, Johannes A.
AU - Abu-Hanna, Ameen
AU - van der Velde, Nathalie
N1 - Funding Information: This work was supported by the innovation funds of Amsterdam UMC, location AMC. The sponsor had no role in the design, methods, subject recruitment, data collections, analysis and preparation of paper. Publisher Copyright: © 2021 The Authors
PY - 2021/10/1
Y1 - 2021/10/1
N2 - Background: Falls and delirium are common complications in older inpatients. Implementation of fall and delirium guidelines is complex and may be facilitated by Clinical Decision Support Systems (CDSSs). Our study aimed to understand the differences between guidelines (work-as-imagined) and actual care (work-as-done) and how these can impact the design of a CDSS. Methods: We used Functional Resonance Analysis Method (FRAM) as structured method to visualize work-as-imagined and work-as-done and to develop an initial CDSS design. As input for work-as-imagined, we used national guidelines. To identify work-as-done and CDSS preferences, we conducted semi-structured interviews in two rounds. We identified differences between guidelines and actual care by creating a FRAM model for work-as-imagined and one for work-as-done. CDSS preferences were coupled to activities in the FRAM models and to the identified barriers and facilitators for following guidelines. Results: Eighteen clinicians participated in 24 individual and small-group interviews. For both falls and delirium, we found substantial differences between work-as-imagined and work-as-done. Several CDSS opportunities to improve fall and delirium care were identified including reminders for screening, an order set to facilitate risk assessment, automatically-generated advice with personalized preventive interventions and support to facilitate medication reviews. The required CDSSs addressed both barriers and facilitators. Conclusion: In our study, work-as-done for falls and delirium differed substantially from work-as-imagined and the preferred CDSSs would address both barriers and facilitators. Furthermore, our study showed that FRAM is a suitable tool to identify differences between actual care and guidelines and to design CDSSs from a user-centred approach.
AB - Background: Falls and delirium are common complications in older inpatients. Implementation of fall and delirium guidelines is complex and may be facilitated by Clinical Decision Support Systems (CDSSs). Our study aimed to understand the differences between guidelines (work-as-imagined) and actual care (work-as-done) and how these can impact the design of a CDSS. Methods: We used Functional Resonance Analysis Method (FRAM) as structured method to visualize work-as-imagined and work-as-done and to develop an initial CDSS design. As input for work-as-imagined, we used national guidelines. To identify work-as-done and CDSS preferences, we conducted semi-structured interviews in two rounds. We identified differences between guidelines and actual care by creating a FRAM model for work-as-imagined and one for work-as-done. CDSS preferences were coupled to activities in the FRAM models and to the identified barriers and facilitators for following guidelines. Results: Eighteen clinicians participated in 24 individual and small-group interviews. For both falls and delirium, we found substantial differences between work-as-imagined and work-as-done. Several CDSS opportunities to improve fall and delirium care were identified including reminders for screening, an order set to facilitate risk assessment, automatically-generated advice with personalized preventive interventions and support to facilitate medication reviews. The required CDSSs addressed both barriers and facilitators. Conclusion: In our study, work-as-done for falls and delirium differed substantially from work-as-imagined and the preferred CDSSs would address both barriers and facilitators. Furthermore, our study showed that FRAM is a suitable tool to identify differences between actual care and guidelines and to design CDSSs from a user-centred approach.
KW - Decision support systems, clinical
KW - Delirium
KW - FRAM model
KW - Fall
KW - Guideline adherence
KW - Hospitals
UR - http://www.scopus.com/inward/record.url?scp=85108713458&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ssci.2021.105355
DO - https://doi.org/10.1016/j.ssci.2021.105355
M3 - Article
SN - 0925-7535
VL - 142
JO - Safety Science
JF - Safety Science
M1 - 105355
ER -