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Implementation of clinical decision support to manage acute kidney injury in secondary care: an ethnographic study

Bailey, Simon, Hunt, Carianne, Sykes, Lynne, Brisley, Adam, Howard, Susan, Blakeman, Tom (2019) Implementation of clinical decision support to manage acute kidney injury in secondary care: an ethnographic study. BMJ Quality & Safety, . ISSN 2044-5415. (doi:10.1136/bmjqs-2019-009932) (KAR id:79159)


Background: Over the past decade, acute kidney injury (AKI) has become a global priority for improving patient safety and health outcomes. In the UK, a confidential inquiry into AKI led to the publication of clinical guidance and a range of policy initiatives. National patient safety directives have focused on the mandatory establishment of clinical decision support systems (CDSSs) within all acute National Health Service (NHS) trusts to improve the detection, alerting and response to AKI. We studied the organisational work of implementing the AKI CDSSs within routine hospital care. Methods: An ethnographic study comprising non-participant observation and interviews was conducted in two NHS hospitals, delivering AKI quality improvement programmes, located in one region of England. Three researchers conducted a total of 49 interviews and 150 hours of observation over an 18-month period. Analysis was conducted collaboratively and iteratively around emergent themes, relating to the organisational work of technology adoption. Results: The two hospitals developed and implemented AKI CDSSs using very different approaches. Nevertheless, both resulted in adaptive work and trade-offs relating to the technology, the users, the organisation, and the wider system of care. A common tension was associated with attempts to maximise benefit whilst minimise additional burden. In both hospitals, resource pressures exacerbated the tensions of translating AKI recommendations into routine practice.


Our analysis highlights a conflicted relationship between external context (policy and resources), and organisational structure and culture (e.g. digital capability, attitudes to quality improvement). Greater consideration is required to the long-term effectiveness of the approaches taken, particularly in light of the ongoing need for adaptation to incorporate new practices into routine work.

Item Type: Article
DOI/Identification number: 10.1136/bmjqs-2019-009932
Divisions: Divisions > Division for the Study of Law, Society and Social Justice > School of Social Policy, Sociology and Social Research > Centre for Health Services Studies
Depositing User: Simon Bailey
Date Deposited: 05 Dec 2019 10:01 UTC
Last Modified: 08 Dec 2022 21:01 UTC
Resource URI: (The current URI for this page, for reference purposes)

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