Aggregating Patient Safety and Status Information in the Electronic Health Record to Support Time-Sensitive Mobility Interventions in the Intensive Care Unit: Protocol for the Design and Testing of a Clinical Decision Support Tool

TL;DR

This study aims to develop a clinical decision support tool in the ICU to help identify patients suitable for mobility interventions and improve functional outcomes.

Contribution

The novel contribution is the development and evaluation of a CDSS interface to streamline ICU mobility interventions based on patient data.

Findings

The study will develop a CDSS prototype through user-centered design methods.

The CDSS will be evaluated for usability and effectiveness in simulated and real ICU settings.

Results will inform a future multisite trial to reduce hospital-acquired functional decline.

Abstract

Patients who require intensive care unit (ICU) care frequently develop hospital-acquired functional decline, defined as a new or worsening loss of ability to perform self-care activities that is associated with prolonged immobility. This morbidity may persist for months to years after hospitalization but is potentially preventable through initiating mobility in the ICU using a multidisciplinary, evidence-based intervention to maintain functional status. While guidelines for ICU physical activity exist, timely identification of patients suitable for activity interventions is an ongoing challenge due to the dynamic nature of critical illness and the number of locations in the electronic health record (EHR) that clinicians need to click in and out of to synthesize patient data. Therefore, there is a critical need to develop an effective knowledge-based clinical decision support system (CDSS) interface in the EHR for efficient identification of patients appropriate for physical activity interventions and coordination of patient-specific activity plans within the ICU team.

The objective of this 2-phase project is to develop a CDSS interface for consistent translation of patient-specific data to inform evidence-based physical activity interventions delivered by registered nurses and physical therapists in ICU settings and evaluate its usability, usefulness, cognitive workload, acceptability, feasibility, and effectiveness on decision-making outcomes.

In phase 1, we will develop a usable, useful, and acceptable CDSS prototype by conducting 4 rounds of user-centered design interviews with registered nurses and physical therapists by using think-aloud and cognitive interview methods. In preparation for implementing CDSS in phase 2, we will conduct semistructured stakeholder interviews using the Consolidated Framework for Implementation Research to identify clinical workflow considerations, potential barriers, and implementation strategies. In phase 2, we will evaluate CDSS’s usability, cognitive workload, acceptability, and effectiveness for activity guideline adoption in two settings: (1) a simulated EHR environment and (2) two adult ICU units in a tertiary care hospital.

This study received funding in April 2024. The CDSS development phase is expected to conclude by December 2025. Data collection and analysis of CDSS evaluation are expected to begin in April 2026 and conclude by December 2028.

We expect the results of this multimethod process for designing, testing efficacy, and identifying barriers to real-world use to have an important positive impact on others who seek to develop safe and effective CDSSs that align with clinical workflow. Importantly, this work will complete the necessary pilot study for a subsequent multisite pragmatic clinical trial to scale the concurrent use of patient data with guideline recommendations at the point of care to deliver evidence-based interventions to reduce hospital-acquired functional decline and its negative, costly outcomes.

DERR1-10.2196/75752

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