A framework synthesis of stakeholder perspectives on clinical decision support tools to inform clinical AI implementation: a qualitative evidence synthesis protocol (Preprint)

BACKGROUND Quantitative systematic reviews have identified clinical artificial intelligence (AI) enabled tools with adequate performance for real-world implementation. To our knowledge, no published report or protocol synthesizes the full breadth of stakeholder perspectives. The absence of such a rigorous foundation perpetuates the ‘AI chasm’ which continues to delay patient benefit. OBJECTIVE To synthesize stakeholder perspectives of computerized clinical decision support tools (CCDST) in any healthcare setting. Synthesized findings will inform future research and the implementation of AI into healthcare services. METHODS The search strategy will use MEDLINE (Ovid), Scopus, CINAHL (EBSCO), ACM Digital Library and Science Citation Index (Web of Science). Following deduplication, title, abstract and full text screening will be performed by two independent reviewers with a third topic expert arbitrating. The quality of included studies will be appraised to support interpretation. Best-fit framework synthesis will be performed, with line-by-line coding completed by two independent reviewers. Where appropriate, these findings will be assigned to one of 22 a-priori themes defined by the Non-Adoption, Abandonment, Scale-Up, Spread and Sustainability (NASSS) framework. New domains will be inductively generated for outlying findings. The placement of findings within themes will be reviewed iteratively by a study advisory group including patient and lay representatives. RESULTS Study registration was obtained from PROSPERO (ID 248025) in May 2021. Final searches were executed in April and screening is ongoing at the time of writing. Full text data analysis is due to be completed in October 2021. We anticipate that the study will be submitted for open-access publication in late 2021 . CONCLUSIONS This paper describes the protocol for a qualitative evidence synthesis aiming to define barriers and facilitators to the implementation of CCDSTs from all relevant stakeholders. The results of this study are intended to expedite the delivery of patient benefit from AI enabled clinical tools. CLINICALTRIAL PROSPERO ID 248025

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72. Improving Antibiotic Prescribing in Interventional Radiology Using Clinical Decision Support Tools to Assess Penicillin Allergies

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.117 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S54-S54

Author(s):

Vidya Atluri ◽

Paula Marsland ◽

Luke M Johnson ◽

Rupali Jain ◽

Paul Pottinger ◽

...

Keyword(s):

Interventional Radiology ◽

Decision Support ◽

Clinical Decision Support ◽

Clinical Decision ◽

Prophylactic Antibiotics ◽

Decision Support Tools ◽

First Line ◽

Support Tools ◽

History Of ◽

Clinical Decision Support Tools

Abstract Background Patients labeled with penicillin allergies often receive alternative antibiotics, leading to increased cost, higher risk of adverse events, and decreased efficacy of procedural prophylaxis. However, most of those patients can tolerate a cephalosporin. University of Washington Medical Center – Montlake (UWMC-ML) Interventional Radiology (IR) frequently administer a pre-procedure prophylactic cephalosporin. We worked with the clinicians in IR to develop tools to allow them to better assess penicillin allergies, make the most appropriate antibiotic choice, and update the patient’s allergy documentation. Methods We identified all patients who underwent procedures in IR between 2017–2019. Chart review was done to determine the procedures performed, patient demographic information, allergies, allergy documentation, and prophylactic antibiotics received. In May 2020 we implemented new Clinical Decision Support tools, including an online assessment app (https://tinyurl.com/IRPCNAllAssess) and handouts to guide antibiotic decision making to clinicians in IR. Results From 2017 to 2019, 381 patients underwent 958 procedures in IR. Of those, 379 patients underwent 496 procedures for which the recommended first line choice for antibiotic prophylaxis is a cephalosporin. Of patients who received pre-procedure prophylactic antibiotics for those procedures, 15.9% [n=11] of patients with penicillin allergies received the first line antibiotic, compared to 89.9% [n=319] of patients without a reported penicillin allergy. Since implementation, the online app has been used to evaluate 9 patients, of whom 8 had penicillin allergies. All 8 patients safely received the first line antibiotic (3 were delabeled, 4 reported a history of mild reactions, and 1 reported a history of an immediate IgE mediated response to penicillin but safely received cefazolin). Conclusion IR evaluates hundreds of patients who may receive prophylactic antibiotics each year. By providing tools to assess penicillin allergies, we were able to improve both their prescribing and de-label patients which will provide a much broader impact on their care than on just their current procedure. Our free tool can be accessed at the website above, and we will demonstrate in person. Disclosures All Authors: No reported disclosures

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