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patients [23]. ICT systems can augment and control group awareness of patient
deterioration, e.g. by preferentially directing alerts to more experienced clinicians. What
DCMT shows is that as far as junior doctors are concerned, such ICT systems need to be
designed with thought to sociotechnical as well as clinical issues to bring about the
desired effects. In addition, no present deteriorating patient risk indicator system is
clearly the best in detection and prediction of clinical outcome. Present RRS risk
indicators for communication are primarily based on physiological indices or subjective
concern and lack accuracy [1]. ICT systems can be used to improve accuracy and
presentation, but not without first addressing their deficiencies in ICT efficiency [23].
5. Conclusion
DCMT is a new theory which can be applied to improve existing ICT systems used for
ward communication and to configure them for the deteriorating patient context. It has
not previously been applied. As the research on which it was based was mostly done at
one hospital, usage would help to confirm or improve its transferability. Its treatment of
ICT system selection as a combination of physical device, software and context is useful
in that each can change over the course of a patient’s deterioration. Although DCMT can
be used in the design of a standalone ICT system, hospitals and individuals usually have
a combination of ICT systems. Consequently, DCMT is better applied to optimise
communication originating from the sender’s interpretation of clinical context to the
entirety of ICT systems which could be used, rather than only considering the design of
one.
DCMT also addresses what occurs when a junior doctor receives communication
about a deteriorating patient, and whether they decide to communicate in turn. It is
affected by social and organisational factors and is not solely dependent on an individual
junior doctor’s knowledge. While DCMT does not specify how to improve these factors,
it can be used to predict their effect on junior doctor communication and thereby to
improve the chances of appropriate escalation of deteriorating patients.
Teaching questions for reflection
1. Would highly accurate prediction of patient risk affect junior doctor escalation
of patients?
2. Is it possible, or desirable, to standardise communication content for the purpose
of improving risk interpretation?
3. If ICT systems automate group awareness of patient deterioration, will junior
doctors independently escalate patients?
References
[1] K. White, I.A. Scott, A.Vaux, C.M. Sullivan, Rapid response teams in adult hospitals: time for another
look ? Intern Med J, 45 (2015), 1211-1220.
[2] D. Massey, L.M. Aitken, W. Chaboyer, What factors influence suboptimal ward care in the acutely ill
ward patient ?, Intensive Crit Care Nurs, 25 (2009), 169-180.
[3] S. Romero-Brufau, J.M. Huddleston, G.J. Escobar, M. Liebow, Why the C-statistic is not informative to
evaluate early warning scores and what metrics to use, Crit Care, 19 (2015), 285-290.
J.Liangetal. / JuniorDoctorCommunicationSystemsand theDCMT 131
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Buch Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners"
Applied Interdisciplinary Theory in Health Informatics
Knowledge Base for Practitioners
- Titel
- Applied Interdisciplinary Theory in Health Informatics
- Untertitel
- Knowledge Base for Practitioners
- Autoren
- Philip Scott
- Nicolette de Keizer
- Andrew Georgiou
- Verlag
- IOS Press BV
- Ort
- Amsterdam
- Datum
- 2019
- Sprache
- englisch
- Lizenz
- CC BY-NC 4.0
- ISBN
- 978-1-61499-991-1
- Abmessungen
- 16.0 x 24.0 cm
- Seiten
- 242
- Kategorie
- Informatik