Understanding and applying practitioner and patient views on the implementation of a novel automated Computer-Aided Risk Score (CARS) predicting the risk of death following emergency medical admission to hospital: qualitative study

Dyson, Judith; Marsh, Claire; Jackson, Natalie; Richardson, Donald; Faisal, Muhammad; Scally, Andrew J; Mohammed, Mohammed

Abstract

Objectives The Computer-Aided Risk Score (CARS) estimates the risk of death following emergency admission to medical wards using routinely collected vital signs and blood test data. Our aim was to elicit the views of healthcare practitioners (staff) and service users and carers (SU/C) on (1) the potential value, unintended consequences and concerns associated with CARS and practitioner views on (2) the issues to consider before embedding CARS into routine practice.

Setting This study was conducted in two National Health Service (NHS) hospital trusts in the North of England. Both had in-house information technology (IT) development teams, mature IT infrastructure with electronic National Early Warning Score (NEWS) and were capable of integrating NEWS with blood test results. The study focused on emergency medical and elderly admissions units. There were 60 and 39 acute medical/elderly admissions beds at the two NHS hospital trusts.

Participants We conducted eight focus groups with 45 healthcare practitioners and two with 11 SU/Cs in two NHS acute hospitals.

Results Staff and SU/Cs recognised the potential of CARS but were clear that the score should not replace or undermine clinical judgments. Staff recognised that CARS could enhance clinical decision-making/judgments and aid communication with patients. They wanted to understand the components of CARS and be reassured about its accuracy but were concerned about the impact on intensive care and blood tests.

Conclusion Risk scores are widely used in healthcare, but their development and implementation do not usually involve input from practitioners and SU/Cs. We contributed to the development of CARS by eliciting views of staff and SU/Cs who provided important, often complex, insights to support the development and implementation of CARS to ensure successful implementation in routine clinical practice.

Citation

Dyson, J., Marsh, C., Jackson, N., Richardson, D., Faisal, M., Scally, A. J., & Mohammed, M. (2019). Understanding and applying practitioner and patient views on the implementation of a novel automated Computer-Aided Risk Score (CARS) predicting the risk of death following emergency medical admission to hospital: qualitative study. BMJ open, 9(4), Article e026591. https://doi.org/10.1136/bmjopen-2018-026591

• Journal Article Type: Article
• Acceptance Date: Mar 11, 2019
• Online Publication Date: Apr 23, 2019
• Publication Date: Apr 23, 2019
• Deposit Date: Jun 11, 2019
• Publicly Available Date: Jun 11, 2019
• Journal: BMJ Open
• Print ISSN: 2044-6055
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 9
• Issue: 4
• Article Number: e026591
• DOI: https://doi.org/10.1136/bmjopen-2018-026591
• Keywords: General Medicine
• Public URL: https://hull-repository.worktribe.com/output/1643822
• Publisher URL: https://bmjopen.bmj.com/content/9/4/e026591
• Contract Date: Jun 11, 2019