Tiong, Ing

Abstract Rationale: Ongoing healthcare staffing shortages have prompted new care paradigms that incorporate remote care delivery to support timely detection of patient physiological deterioration through mechanisms other than clinician bedside evaluations. In partnership with institutional Information Technology, our team has developed a unique clinical informatics environment, known as the Advanced Medical Practice (AMP) platform, that incorporates data from multiple sources and platforms and supports remote observation of patients from the electronic intensive care unit(eICU). AMP takes advantage of technologies outside of vendor-supported EHRs, and its advanced user-interface design reduces information overload while incorporating real-time data from novel devices and sensors. We partnered with the hospital practice to co-develop a score within the AMP platform(Clinical Events Detection and Response[CEDAR]) that incorporates heart rate, blood pressure, respiratory rate, and SpO2 to stratify patient risk and generate deterioration alerts for the electronic ICU(eICU) team. This formative evaluation employed an implementation science approach to refine CEDAR and ensure it is acceptable to users and can be feasibly implemented in practice. Methods: The study team conducted this pilot work in the eICU at Mayo Clinic (Rochester, MN). We observed the eICU workflow and documented feedback from eICU staff in fieldnotes. eICU staff were asked to log issues in a tracking file during shifts. Issues were reviewed daily and discussed at multidisciplinary team meetings weekly. Observation and tracking data were coded to constructs in the Consolidated Framework for Implementation Research(CFIR 2.0) framework and mapped to Expert Recommendations for Implementation Change(ERIC) strategies that targeted key determinants. Results: Between 9/23/24 and 10/25/24 we completed 25 days of observations. Most identified issues related to technical/design issues like unclear vital trigger alerts (CFIR: Innovation trialability and design); staff knowledge of CEDAR functionality and attitudes about functionality, complexity, or relative advantage compared to current systems (CFIR: Inner setting access to knowledge and information and relative advantage); and difficulties incorporating CEDAR into workflow(CFIR: Inner setting/compatibility). Implementation strategies mapped to CFIR determinants included promoting adaptability of customized interface features; staging implementation scale-up with iterative improvements; providing local technical assistance; assessing for readiness and identifying facilitators and barriers; and conducting educational outreach visits. Conclusions: Formative evaluation during pilot studies are a critical step in the process of intervention development and testing. User engagement and frameworks from implementation science can identify issues of feasibility and inform strategies to ensure acceptability prior to intervention scale-up in clinical practice and readiness for conducting larger implementation studies.