Seite - 131 - in Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners

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