title: Computerized clinical decision support for the early recognition and management of acute kidney injury: a qualitative evaluation of end-user experience.
abstract: BACKGROUND
  Although the efficacy of computerized clinical decision support (CCDS) for acute kidney injury (AKI) remains unclear, the wider literature includes examples of limited acceptability and equivocal benefit. Our single-centre study aimed to identify factors promoting or inhibiting use of in-patient AKI CCDS.
  
  
  METHODS
  Targeting medical users, CCDS triggered with a serum creatinine rise of ≥25 μmol/L/day and linked to guidance and test ordering. User experience was evaluated through retrospective interviews, conducted and analysed according to Normalization Process Theory. Initial pilot ward experience allowed tool refinement. Assessments continued following CCDS activation across all adult, non-critical care wards.
  
  
  RESULTS
  Thematic saturation was achieved with 24 interviews. The alert was accepted as a potentially useful prompt to early clinical re-assessment by many trainees. Senior staff were more sceptical, tending to view it as a hindrance. 'Pop-ups' and mandated engagement before alert dismissal were universally unpopular due to workflow disruption. Users were driven to close out of the alert as soon as possible to review historical creatinines and to continue with the intended workflow.
  
  
  CONCLUSIONS
  Our study revealed themes similar to those previously described in non-AKI settings. Systems intruding on workflow, particularly involving complex interactions, may be unsustainable even if there has been a positive impact on care. The optimal balance between intrusion and clinical benefit of AKI CCDS requires further evaluation.
authors.affiliation: Renal Services, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK; Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Nigel S
authors.initials: NS
authors.lastname: Kanagasundaram
authors.affiliation: Faculty of Health and Life Sciences , Northumbria University , Newcastle upon Tyne , UK.
authors.forename: Mark T
authors.initials: MT
authors.lastname: Bevan
authors.affiliation: Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK; Regional Medical Physics, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Sims
authors.affiliation: Department of Pharmacy , Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle upon Tyne , UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Heed
authors.affiliation: Department of Infectious Diseases , Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle upon Tyne , UK.
authors.forename: David A
authors.initials: DA
authors.lastname: Price
authors.affiliation: Renal Services, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK; Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Neil S
authors.initials: NS
authors.lastname: Sheerin
keywords: acute kidney injury; clinical decision support systems