Improving Identification and Coordination of Mobility Interventions in the ICU Using Clinical Decision Support

Project Summary Patients who require intensive care unit (ICU) level of care frequently develop hospital-acquired functional decline, a new or worsening loss of ability to perform self-care activities that is associated with prolonged periods in immobility. This morbidity is potentially preventable through initiating mobility interventions in the ICU using a multidisciplinary, evidence-based intervention to maintain functional status. While guidelines for ICU patients' physical activity exist, timely identification of patients suitable for activity interventions is an ongoing challenge due to the dynamic nature of critical illness and the number of locations in the electronic health record (EHR) that clinicians need to click in and out of to synthesize patient data. There is, therefore, a critical need to develop an effective clinical decision support system (CDSS) interface in the EHR for efficient identification of patients appropriate for physical activity interventions and coordination of patient-specific activity plans within the ICU team. Our long- term goal is to accelerate the development and implementation of clinically useful CDSS to prevent hospital-acquired functional decline. Our overall objective is to develop a CDSS interface for consistent patient-specific translation of evidence-based physical activity interventions for ICU settings, and evaluate its usability, usefulness, cognitive workload, acceptability, feasibility, and effectiveness on decision-making outcomes. The proposed project has two phases and four specific aims. In Phase 1 (R21), we will develop a useable, useful, and acceptable CDSS prototype by conducting clinician interviews and a user-centered design approach (R21 Aim 1), and identify clinical workflow considerations, potential barriers, and implementation strategies in preparation for evaluating the feasibility and effectiveness of the CDSS (R21 Aim 2). In Phase 2 (R33), we will evaluate the CDSS usability, cognitive workload, acceptability, and effectiveness for activity guideline adoption in a simulated EHR environment (R33 Aim 3) and on two ICU units in one tertiary care hospital (R33 Aim 4). The results are expected to have an important positive impact by providing strong justification for a subsequent multi-site pragmatic R01-level clinical trial to scale the concurrent use of patient data with guideline recommendations at the point of care to deliver evidence-based interventions to reduce hospital-acquired functional decline at its negative, costly outcomes.