Abstract
Background: Treatment of pressure injury (PI) stage III and IV in patients with spinal cord injury (SCI) requires complex interdisciplinary and inter-professional management described in comprehensive concepts. Although the implementation of these concepts in the clinical management is still difficult due to practical aspects as information and coordination challenges for example. The aim of this study was to develop, implement and test a computerized decision support system (CDSS) to increase concept adherence, improve inter-professional collaboration and optimize clinical outcome compared to usual care. Method: We implemented a CDSS picturing the Basel Decubitus Concept in an acute and rehabilitation clinic specialized for SCI as part of a quality improvement project in a real life two-group parallel design. We randomly allocated patients with SCI and PI stage III/IV for inpatient treatment to usual or CDSS supported care. We used an inclusive participatory development process, a qualitative focus group-based (30 participants) approach to capture the user perspective and prospective chart analyses to compare complication rates, length of stay and costs. Results: In both groups 15 patients were included showing no differences in SCI characteristics, comorbidities, and PI characteristics (localisation: ischium (19 PI, 63%), sacrum (10 PI, 33%), recurrent PI in 21 patients (70%)). Twenty-seven patients received surgical treatment (rotation flap in 12 patients (40%), posterior thigh flap in 15 patients (50%)). No statistically significant group differences were observed in the frequency of major (20% vs 13% between CDSS and control group) and minor (33% vs 27%) complications and length of stay (98 (±28) vs 81 (±23) days). The costs were similar. Although, health care professionals experienced the CDSS as helpful, high workload and difficulties in the information technology processes hindered its implementation.Conclusion: The introduction of a CDSS in the treatment of PI stage III/IV in patients with SCI was feasible, but technical and application problems limited its effectiveness. During the implementation and testing we learned that a clear definition of the whole treatment concept includes milestones, interventions and outcome definition. Technical requirements should include efficient reminder systems and clear visibility for all disciplines of the whole process. Trial registration: As a quality assurance study, this project holds a declaration of no objection by the Ethics Committee northwest/central Switzerland (EKNZ UBE-16/003) and received an ethical approval (EKNZ Req-2017-00860).
