Implementation and clinical utility of a Computer-Aided Risk Score for Mortality (CARM): a qualitative study.

OBJECTIVES: The Computer-Aided Risk Score for Mortality (CARM) estimates the risk of in-hospital mortality following acute admission to the hospital by automatically amalgamating physiological measures, blood tests, gender, age and COVID-19 status. Our aims were to implement the score with a small group of practitioners and understand their first-hand experience of interacting with the score in situ. DESIGN: Pilot implementation evaluation study involving qualitative interviews. SETTING: This study was conducted in one of the two National Health Service hospital trusts in the North of England in which the score was developed. PARTICIPANTS: Medical, older person and ICU/anaesthetic consultants and specialist grade registrars (n=116) and critical outreach nurses (n=7) were given access to CARM. Nine interviews were conducted in total, with eight doctors and one critical care outreach nurse. INTERVENTIONS: Participants were given access to the CARM score, visible after login to the patients' electronic record, along with information about the development and intended use of the score. RESULTS: Four themes and 14 subthemes emerged from reflexive thematic analysis: (1) current use (including support or challenge clinical judgement and decision making, communicating risk of mortality and professional curiosity); (2) barriers and facilitators to use (including litigation, resource needs, perception of the evidence base, strengths and limitations), (3) implementation support needs (including roll-out and integration, access, training and education); and (4) recommendations for development (including presentation and functionality and potential additional data). Barriers and facilitators to use, and recommendations for development featured highly across most interviews. CONCLUSION: Our in situ evaluation of the pilot implementation of CARM demonstrated its scope in supporting clinical decision making and communicating risk of mortality between clinical colleagues and with service users. It suggested to us barriers to implementation of the score. Our findings may support those seeking to develop, implement or improve the adoption of risk scores.

Learning in lockdown: exploring the impact of COVID-19 on interprofessional education

The COVID-19 pandemic has had a significant impact on the learning experiences of students undertaking health and social care programmes across the globe. In the UK, the Nursing and Midwifery Council introduced emergency standards for undergraduate programmes in 2020, making significant short-term changes to programme delivery. However, the mandate for all students to undertake interprofessional education remained. Interprofessional education is key to preparing students on health and social care programmes, as it enables students to work as effective members of multi-agency/multi-professional teams on qualification. It is an important element of training, as it has a direct impact on quality of care and service user experience. This series of articles will explore the experiences of 'lockdown learning' from the perspective of academics, students and service users from a global perspective in relation to the delivery of interprofessional education during the pandemic, which necessitated a wholesale move from face-to-face, blended and online learning to include emergency remote teaching. The series was written by members of the Centre for the Advancement of Interprofessional Education Research Subgroup (Interprofessional Education Experiences) and aims to identify barriers and facilitators to successful shared learning and provide suggestions for how lessons learned can be taken forward to further enhance this important element of pre-registration education. The perceptions and attitudes of academics and students on such comprehensive changes are a unique and rich data source to explore and inform future provision. [ABSTRACT FROM AUTHOR] Copyright of British Journal of Midwifery is the property of Mark Allen Holdings Limited and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)