Decision support systems in the Intensive Care Unit: Nurses' and physicians' experiences

The purpose of this study was to generate a grounded theory to understand the experiences of nurses and physicians with a Decision Support System (DSS) in the Intensive Care Unit (ICU). The research question answered by this study was "What are the perceived experiences of nurses and physicians using a DSS in the ICU?";A qualitative research design using the grounded theory method was employed in this study. Participants were recruited from a large urban Midwestern medical center. Single in-depth, audiotaped interviews were conducted. Through open-ended questions based on the interview guide designed for this study, participants defined what they considered to be relevant experiences of using a DSS in the ICU and identified the interrelatedness of conceptual categories that emerged from the data. Data were analyzed using the constant comparative analysis method.;A total of 33 convenient participants (23 nurses and 10 physicians) were included in this study. Nurse participants were predominantly female, Caucasian, had access to the DSS for 10--14 months, and had attended a formal class to learn about DSS. Physician participants were predominantly male, Caucasian, had the same DSS access time, and had learned about DSS from self-study or another colleague with DSS knowledge. Participants were recruited from five ICU's within the medical center. The DSS used by participants in this study was the Acute Physiological Age, Chronic Health Evaluation (APACHE) III decision support system.;The core variable that described the experiences of nurses and physicians using a DSS in the ICU was the process of "forecasting decision outcomes." This was a voluntary process employed by nurses and physicians to forecast the outcomes of patient care decisions in the ICU prior to actual decision making. Participants perceived using the DSS to forecast decision outcomes prior to actual decision making as the most significant use of the DSS in the ICU. Forecasting decision outcomes was characterized by four major categories: DSS learning, understanding DSS technology, creating DSS inferences, and trusting DSS derived data. Each of these categories is defined and the relationships between the categories are explained.;The findings of this study suggest that the driving force for DSS use in the ICU is primarily to forecast the outcomes of patient care decisions prior to actual decision making. The findings also propose factors associated with DSS use. Implications for nursing, medicine, and future research are presented.