To NIRS or not: understanding clinical decision-making of respiratory support management related to acute respiratory failure using Critical Decision Method

Abstract

Clinical decisions related to noninvasive respiratory support (NIRS) for acute respiratory failure patients are complex. NIRS strategies have favorable benefits for patients when successful but NIRS failure comes with longer ICU stays, increased mortality, and more intubation-related and mechanical ventilator-associated complications. Our goal is to understand how physicians make decisions regarding NIRS and explore the differences between emergency physicians and critical care physicians—who commonly make these decisions. We used the critical decision method to conduct ten semi-structured interviews with five emergency physicians and five critical care physicians from ten different healthcare systems across the United States. We found that physicians similarly use objective and subjective clinical cues but differentially use temporal and contextual cues in their decision-making. Several insights identified in our study can be helpful in the design and development of clinical decision support systems for respiratory support decision-making. Specifically, we recommend two customized distinct clinical decision support systems for respiratory support decision-making, one for each designated clinical setting (i.e., ED and ICU) with tailored designs that support the different decision-making processes.

Keywords:

• Critical decision method
• cognitive task analysis
• clinical decision-making
• acute respiratory failure
• noninvasive respiratory support

Disclosure statement

No potential conflict of interest was reported by the author(s).

Informed consent

The study was approved by the University of Arizona and Banner Health Institutional Review Boards. Each participant electronically consented to participate in the study via REDCap^®

Additional information

Funding

This research was funded, in part, by an Emergency Medicine Foundation grant sponsored by Fisher & Paykel and in part by the National Science Foundation under grant 1838745. Neither funding agency nor sponsor was involved in the design or conduct of the study or interpretation and presentation of the results.