Effective Use of Clinical Decision Support in Critical Care: Using Risk Assessment Framework for Evaluation of a Computerized Weaning Protocol

  • Sahiti MyneniEmail author
  • Debra McGinnis
  • Khalid Almoosa
  • Trevor Cohen
  • Bela Patel
  • Vimla L. Patel
Part of the Annals of Information Systems book series (AOIS, volume 19)


Background: Clinical decision support aids such as computerized weaning protocols (CWPs) aim to reduce medical errors and improve patient safety. However, the dynamic nature of critical care environments demands context-specific and complexity -inclusive assessment of these support tools for optimal results.

Objective: To apply and validate the use of a risk assessment method called Functional Resonance Accident Method (FRAM), which is originally proposed for adverse event analysis in the aviation industry, to evaluate effective use of a CWP in a medical intensive care unit.

Study Design and Methods: Multiple data collection methods including (1) ethnographic observations, (2) semi-structured interviews, and (3) review of hospital documents related to workflow, procedures, and training were used to simulate a FRAM based model of the CWP and identify factors affecting its use. Subsequently, we validated our findings by shadowing clinicians during 65 weaning attempts (120 h of in vivo data).

Results: The factors posing risk to effective use of CWP included misinterpretation of CWP’s sedation assessment scale, communication and collaboration breakdowns, problems with on-time support delivery, and negative perception of the protocol among clinicians. During the in-situ validation, we found that 45 of the 65 attempts were favorable, 16 fell under near-miss category, while the remaining four were unfavorable.

Conclusions: Non-linear risk assessment method based on resilience engineering concepts is an effective approach for identification of factors for safe use of decision support aids in the real- world health care environment.


Complexity Medical error Risk assessment Computerized weaning protocol Clinical decision support 



This research was supported by an award from the James S McDonnell Foundation (Grant 220020152) to Vimla Patel. We thank all of the clinicians for their time and involvement in the study.

Disclosures: The authors have nothing to disclose and have no Conflict of Interest.


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Sahiti Myneni
    • 1
    Email author
  • Debra McGinnis
    • 2
  • Khalid Almoosa
    • 3
  • Trevor Cohen
    • 1
  • Bela Patel
    • 3
  • Vimla L. Patel
    • 4
  1. 1.Center for Cognitive Informatics and Decision MakingSchool of Biomedical Informatics, UT HealthHoustonUSA
  2. 2.Memorial Hermann HospitalHoustonUSA
  3. 3.Divisions of Critical Care MedicineUT HealthHoustonUSA
  4. 4.Center for Cognitive Studies in Medicine and Public HealthNew York Academy of MedicineNew YorkUSA

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