Evidence mapPaperPMID 39405513Full record

ArticleJMIR human factors2024

Views and Uses of Sepsis Digital Alerts in National Health Service Trusts in England: Qualitative Study With Health Care Professionals.

Runa Lazzarino, Aleksandra J Borek, Kate Honeyford, John Welch, Andrew J Brent, Anne Kinderlerer, Graham Cooke, Shashank Patil, Anthony Gordon, Ben Glampson and 5 more

Abstract read
In one paragraph

Article in JMIR human factors, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Article
  2. Review
  3. Article
  4. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Runa LazzarinoNuffield Department of Primary Care Health Sciences, Medical Division, University of Oxford, Oxford, United Kingdom.ORCID 0000-0002-4206-4913
Aleksandra J BorekNuffield Department of Primary Care Health Sciences, Medical Division, University of Oxford, Oxford, United Kingdom.ORCID 0000-0001-6029-5291
Kate HoneyfordTeam Health Informatics, Institute of Cancer Research, London, United Kingdom.ORCID 0000-0002-5533-7693
John WelchUniversity College Hospital, London, United Kingdom.ORCID 0000-0001-9172-3869
Andrew J BrentOxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.ORCID 0000-0002-5349-0723
Anne KinderlererImperial College Healthcare NHS Trust, London, United Kingdom.ORCID 0009-0001-3815-6727
Graham CookeImperial College Healthcare NHS Trust, London, United Kingdom.ORCID 0000-0001-6475-5056
Shashank PatilChelsea and Westminster Hospital, London, United Kingdom.ORCID 0000-0002-0926-1990
Anthony GordonImperial College Healthcare NHS Trust, London, United Kingdom.ORCID 0000-0002-0419-547X
Ben GlampsonImperial College Healthcare NHS Trust, London, United Kingdom.ORCID 0000-0002-5601-5581
Philippa GoodmanPPI representative, Oxford, United Kingdom.ORCID 0009-0008-7686-8953
Peter GhazalSchool of Medicine, Cardiff University, Cardiff, United Kingdom.ORCID 0000-0003-0035-2228
Ron DanielsUK Sepsis Trust and Global Sepsis Alliance, Birmingham, United Kingdom.ORCID 0009-0000-2269-1955
Céire E CostelloeTeam Health Informatics, Institute of Cancer Research, London, United Kingdom.ORCID 0000-0002-3475-7525
Sarah Tonkin-CrineNuffield Department of Primary Care Health Sciences, Medical Division, University of Oxford, Oxford, United Kingdom.ORCID 0000-0003-4470-1151

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundSepsis is a common cause of serious illness and death. Sepsis management remains challenging and suboptimal. To support rapid sepsis diagnosis and treatment, screening tools have been embedded into hospital digital systems to appear as digital alerts. The implementation of digital alerts to improve the management of sepsis and deterioration is a complex intervention that has to fit with team workflow and the views and practices of hospital staff. Despite the importance of human decision-making and behavior in optimal implementation, there are limited qualitative studies that explore the views and experiences of health care professionals regarding digital alerts as sepsis or deterioration computerized clinician decision support systems (CCDSSs).

objectiveThis study aims to explore the views and experiences of health care professionals on the use of sepsis or deterioration CCDSSs and to identify barriers and facilitators to their implementation and use in National Health Service (NHS) hospitals.

methodsWe conducted a qualitative, multisite study with unstructured observations and semistructured interviews with health care professionals from emergency departments, outreach teams, and intensive or acute units in 3 NHS hospital trusts in England. Data from both interviews and observations were analyzed together inductively using thematic analysis.

resultsA total of 22 health care professionals were interviewed, and 12 observation sessions were undertaken. A total of four themes regarding digital alerts were identified: (1) support decision-making as nested in electronic health records, but never substitute professionals' knowledge and experience; (2) remind to take action according to the context, such as the hospital unit and the job role; (3) improve the alerts and their introduction, by making them more accessible, easy to use, not intrusive, more accurate, as well as integrated across the whole health care system; and (4) contextual factors affecting views and use of alerts in the NHS trusts. Digital alerts are more optimally used in general hospital units with a lower senior decision maker:patient ratio and by health care professionals with experience of a similar technology. Better use of the alerts was associated with quality improvement initiatives and continuous sepsis training. The trusts' features, such as the presence of a 24/7 emergency outreach team, good technological resources, and staffing and teamwork, favored a more optimal use.

conclusionsTrust implementation of sepsis or deterioration CCDSSs requires support on multiple levels and at all phases of the intervention, starting from a prego-live analysis addressing organizational needs and readiness. Advancements toward minimally disruptive and smart digital alerts as sepsis or deterioration CCDSSs, which are more accurate and specific but at the same time scalable and accessible, require policy changes and investments in multidisciplinary research.

Indexed as

Decision Support Systems, ClinicalHealth PersonnelQualitative ResearchSepsisState MedicineAttitude of Health PersonnelEnglandHumanscomputerized clinical decision support systemsdecision-makingdigital alertselectronic health recordsemergency careEnglandintensive carepatient deteriorationqualitative studysecondary caresepsis

Identifiers

PMID39405513
PMCPMC11522658

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.