Barriers and facilitators of the use of critical care information systems in the intensive care unit - A qualitative interview study (Preprint)

Abstract

Critical care information systems (CCIS) can have positive, neutral or negative effects on clinical care in intensive care units (ICUs) and the job satisfaction of ICU staff. Central mediating factors here are a high usability of the IT system and sufficient training, but also possible occuring resistance generated by increased control via the system and lack of participation. The usability of CCIS and co-determination factors in connection with CCIS use are not sufficiently examined.

The aim of the study was to investigate the usage barriers of CCIS to derive recommendations for action for manufacturing companies and hospitals. The aim was to directly address previously researched potentially relevant factors and at the same time to leave room for free comments.

Ten semi-structured qualitative interviews of 1 hour were conducted with ICU staff of 3 ICUs of a German university hospital (4 nurses, 6 doctors) where the CCIS was also reviewed together. The 10 interviews were recorded, transcribed, coded with MAXQDA and analyzed in terms of content structure (deductive and inductive).

: A total of 86 different usability problems was found, which were divided into 7 main categories and 22 subcategories. Particularly relevant were the unclear presentation of information (especially in medication documentation and order), too small or lengthy interaction steps in documentation (especially in nursing documentation), missing information or information distributed on different pages (especially also missing reminders of new entries), necessary duplicate entries of data and too low a speed of the system. Independently of this, other problems mentioned in connection with the use of the system were categorized as training, co-determination, feeling of being hazed, standard operating procedures and process changes. Satisfaction with the system was described as directly related to job satisfaction.

The usability of the CCIS is a central factor for the satisfaction with the IT system and can explain why CCIS use can have such opposing outcomes. Improving the usability of a complex system like an CCIS is a promising but challenging task and should involve iterative user testing. As co-determination is a relevant factor for use satisfaction, a comprehensive, transparent communication and opportunities for employee participation should be established. Sufficient training opportunities and SOPs for the system should also be a focus. System implementation requires sufficient monetary and time resources to create effective organizational structures and roles that can enable an effective feedback structure and system development.