Implementation and clinical utility of a Computer Aided Risk score for Mortality (CARM): A qualitative study

Dyson, Judith and McCrorie, Carolyn and Benn, Jonathan and Richardson, Donald and Marsh, Claire and Bowskill, Gill and Double, Keith and Gallagher, Jean and Faisal, Muhammad and Mohammed, Mohammed A. (2023) Implementation and clinical utility of a Computer Aided Risk score for Mortality (CARM): A qualitative study. BMJ Open, 13 (1). e061298. ISSN 2044-6055

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Objectives: The Computer-Aided Risk score for Mortality (CARM) estimates the risk of in-hospital mortality following acute admission to hospital by automatically amalgamating physiological measures, blood tests, gender, age and Covid-19 status. Our aim was to implement the score with a small group of practitioners and understand their first-hand experience of interacting with the score in-situ.
Design: Pilot implementation evaluation study involving qualitative interviews.
Setting: This study was conducted in one of the two National Health Service hospital trusts in the North of England in which the score was developed.
Participants: Medical, older person and ICU/Anaesthetic consultants and specialist grade registrars (n=116) and critical outreach nurses (n=7) were given access to CARM. Nine interviews were conducted in total, with eight doctors and one Critical Care Outreach Nurse.
Interventions: Participants were given access to the CARM score, visible after login to the patients’ electronic record, along with information about the development and intended use of the score.
Results: Four themes and fourteen subthemes emerged from reflexive thematic analysis; 1 current use (including support or challenge clinical judgement and decision making, communicating risk of mortality and professional curiosity), 2 barriers and facilitators to use (including litigation, resource needs, perception of the evidence base, strengths and limitations), 3 implementation support needs (including roll out and integration, access, training and education) and 4 recommendations for development (including presentation and functionality and potential additional data). Barriers and facilitators to use, and recommendations for development featured highly across most interviews.
Conclusions: Our in-situ evaluation of the pilot implementation of CARM demonstrated its scope in supporting clinical decision making and communicating risk of mortality between clinical colleagues and with service users. It suggested to us barriers to implementation of the score. Our findings may support those seeking to develop, implement or improve the adoption of risk scores.
Strengths and limitations
• Our development of CARM has benefited from the input of practitioners, service users and carers with regard to its content, presentation, use and implementation.
• Due to the scarcity of practitioner time during the period of Covid -19 our participant interviews were limited to n=9

Item Type: Article
Identification Number:
15 December 2022Accepted
17 January 2023Published Online
Uncontrolled Keywords: risk score, implementation, mortality
Subjects: CAH02 - subjects allied to medicine > CAH02-04 - nursing and midwifery > CAH02-04-01 - nursing (non-specific)
Divisions: Faculty of Health, Education and Life Sciences > Centre for Social Care, Health and Related Research (C-SHARR)
Depositing User: Judith Dyson
Date Deposited: 16 Dec 2022 09:39
Last Modified: 20 Jan 2023 13:38

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