Registered Nurses' experiences of using a clinical decision support system for triage of emergency calls: A qualitative interview study

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. 摘要 目的 描述注册护士如何利用临床决策支持系统,从专业自主权的角度,对紧急医疗调度中心的呼叫进行分类。 设计 本研究采用定性归纳法进行描述性设计。 方法 在2018年至2019年间,对24名注册护士进行访谈。并开展了专题分析。 结果 确定了5大主题和16个子主题:(a)使用CDSS作为紧急呼叫专业能力的常规支持,涉及子主题:专业能力支持,思考帮助,强制性支持;(b)艰难情况下的具体实用支持,涉及子主题:RN疲劳或压力过大;症状模糊和不清楚、罕见情况、激进的和焦躁的呼叫者;(c)使用CDSS,但改变分诊建议/优先级,涉及子主题:建议高于CDSS的优先级,建议低于CDSS的优先级;(d)与其他服务部门合作,开发相关领域以更好地使用CDSS,涉及子主题:请求与救护车建立共同文件系统,并与全国电话护理热线密切合作;以及(e)实现理想运用的CDSS可行技术开发领域,涉及子主题:图像传输、医疗记录、CDSS特定区域开发、地图更新、增长知识的需求。 结论 不应将CDSS视为是职业自主性的限制。其在极少数情况下特别有用。应与注册护士密切合作完成技