Registered Nurses' experiences of using a clinical decision support system for triage of emergency calls: A qualitative interview study
Inger K. Holmström, Elenor Kaminsky, Ylva Lindberg, Douglas Spangler, Ulrika Winblad
Abstract
OBJECTIVES: To describe how Registered Nurses make use of a Clinical Decision Support System to triage calls to emergency medical dispatch centres, from the perspective of professional autonomy. DESIGN: The study had a descriptive design with a qualitative inductive approach. METHODS: Interviews were done with 24 Registered Nurses during 2018-2019. Thematic analysis was conducted. RESULTS: Five themes and 16 subthemes were established: (a) Using the CDSS as a general support to professional competence in emergency calls, including subthemes: Support for professional competence, an aid to reflection, a compulsory support; (b) A specific support useful in difficult situations and calls, with subthemes: RN being tired or stressed out; vague and unclear symptoms, rare situations, aggressive and agitated callers; (c) Using the CDSS but changing triage recommendations/priority, including subthemes: Recommending a higher priority than the CDSS and recommending a lower priority than the CDSS; (d) Development areas for better use of the CDSS in collaboration with other services, with subthemes: Request for common documentation system with ambulances and closer collaboration with the national telephone nursing helpline; and (e) Possible technical development areas in the CDSS for optimal use, including subthemes: image transfer, medical records, development of certain areas in the CDSS, update of maps, a need for more knowledge. CONCLUSION: The CDSS was not perceived as a restriction on professional autonomy. It was particularly useful in rare situations. Technical improvements as well as education and training should be done in close collaboration with registered nurses. IMPACT: The study contributes with knowledge about how registered nurses triaging emergency calls use a decision support system. The system was a support for professional competence and did not seem to restrict them. The findings could be useful for clinicians and researchers in development of telephone triage and decision support systems.