Investigating Why Clinicians Deviate from Standards of Care: Liberating Patients from Mechanical Ventilation in the ICU

Abstract

Clinical practice guidelines, care pathways, and protocols are designed to support evidence-based practices for clinicians; however, their adoption remains a challenge. We set out to investigate why clinicians deviate from the ``Wake Up and Breathe'' protocol, an evidence-based guideline for liberating patients from mechanical ventilation in the intensive care unit (ICU). We conducted over 40 hours of direct observations of live clinical workflows, 17 interviews with frontline care providers, and 4 co-design workshops at three different medical intensive care units. Our findings indicate that unlike prior literature suggests, disagreement with the protocol is not a substantial barrier to adoption. Instead, the uncertainty surrounding the application of the protocol for individual patients leads clinicians to deprioritize adoption in favor of tasks where they have high certainty. Reflecting on these insights, we identify opportunities for technical systems to help clinicians in effectively executing the protocol and discuss future directions for HCI research to support the integration of protocols into clinical practice in complex, team-based healthcare settings.

to appear at CHI 2024

References in corpus (4)

• Unremarkable AI: Fitting Intelligent Decision Support into Critical, Clinical Decision-Making Processes
• Designing AI for Trust and Collaboration in Time-Constrained Medical Decisions: A Sociotechnical Lens
• Sketching AI Concepts with Capabilities and Examples: AI Innovation in the Intensive Care Unit
• Ground Truth Or Dare: Factors Affecting The Creation Of Medical Datasets For Training AI

Cited by in corpus (2)

• Multimodal Healthcare AI: Identifying and Designing Clinically Relevant Vision-Language Applications for Radiology
• Sketching AI Concepts with Capabilities and Examples: AI Innovation in the Intensive Care Unit