Barriers and Facilitators of the Use of Computerized Critical Care Information Systems in the Intensive Care Unit: Qualitative Interview Study.

Abstract

Computerized critical care information systems (CCIS) can have a range of positive to negative impacts on clinical care in ICUs and the job satisfaction of ICU staff. Key factors influencing these effects include the usability of the IT system and the level of training provided. Resistance to using the system may arise from users due to increased control imposed by the system and from insufficient participation in its development and configuration. The usability of CCIS, along with other important barriers such as co-determination, has not been thoroughly examined. The study investigates barriers to using CCIS and aims to provide actionable recommendations for manufacturing companies and hospitals to ensure the successful implementation and use of CCIS. It focuses on known usability factors while incorporating open feedback from current users to uncover new insights and identify additional usability factors not previously documented in the literature. We conducted 10 semistructured qualitative interviews with ICU staff (4 nurses and 6 doctors) from 3 ICUs at a large German university hospital. Each interview lasted 1 hour and focused on providing a collective assessment of the CCIS. The interviews were recorded, transcribed, and coded using MAXQDA and then analyzed through both deductive and inductive content structure methods. A total of 86 distinct usability issues were identified and categorized into 7 main groups and 23 subgroups. The most common usability issues were (1) unclear information presentation, especially for medication; (2) overly lengthy or small interaction steps in documentation; (3) missing or scattered information across sections; (4) redundant data entry requirements; and (5) slow system speed. Additionally, other challenges associated with system usage included training, co-determination, the perception of feeling constrained, adherence to standard operating procedures, and changes in processes. Participants in the study highlighted that the level of contentment with the system has a direct influence on their job satisfaction. CCIS usability greatly influences satisfaction with the information technology system. Enhancing CCIS usability requires ongoing user testing and transparent employee involvement. Adequate training and standard operating procedure implementation are crucial. Investing time and financial resources in organizational frameworks and feedback mechanisms is an imperative for the successful implementation of CCIS.