Navigating Clinical Decision Support Systems in Emergency Medical Services: Balancing Professional Judgment and Technological Integration
DOI:
https://doi.org/10.7577/pp.5924Abstract
This article illustrates how clinical decision support systems (CDSS) are integrated into clinical reasoning and affect decision-making processes in emergency medical services (EMS). CDSS aims to assist clinical reasoning with relevant patient information and medical knowledge, facilitating decision-making. As CDSS become increasingly significant in Swedish healthcare, understanding their implementation is critical, particularly as technological innovations may reshape clinical reasoning and professionals’ decision-making. The study draws on empirical data from observations and interviews with registered nurses (RNs) in a simulation project. Findings illustrate how clinical reasoning is a collective process among colleagues and how emotions and tacit knowledge are central to professional judgment. Although RNs express confidence in technical systems assisting clinical reasoning, they remain skeptical in situations requiring compromises to their judgment based on CDSS outputs. Finally, the article problematizes the effects on RNs when working with unsynchronized or insufficiently functioning technical systems.
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Andersson Hagiwara, M., Lundberg, L., Sjöqvist, B. A., & Maurin Söderholm, H. (2019). The effects of integrated IT support on the prehospital stroke process: Results from a realistic experiment. Journal of Healthcare Informatics Research, 3, 300–328. https://doi.org/10.1007/s41666-019-00053-4
Andersson, U., Andersson Hagiwara, M., Wireklint Sundström, B., Andersson, H., & Maurin Söderholm, H. (2022). Clinical reasoning among registered nurses in emergency medical services: A case study. Journal of Cognitive Engineering and Decision Making, 16(3), 123–156. https://doi.org/10.1177/15553434221097788
Andersson U., Maurin Söderholm H., Andersson H., Wireklint Sundström B., Andersson Hagiwara M., & Puaca G. (2024). Organizational factors influencing clinical reasoning in a Swedish emergency medical service organization: An explorative qualitative case study. Paramedicine, 21(1), 5–15. https://doi:10.1177/27536386231189011
Andersson, U., Maurin Söderholm, H., Wireklint Sundström, B., Andersson Hagiwara, M., & Andersson, H. (2019). Clinical reasoning in the emergency medical services: An integrative review. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 27(1), 1–12. https://doi.org/10.1186/s13049-019-0646-y
Asakura, K., Gheorghe, R. M., Borgen, S., Sewell, K., & MacDonald, H. (2021). Using simulation as an investigative methodology in researching competencies of clinical social work practice: A scoping review. Clinical Social Work Journal, 49, 231–243. https://doi: 10.1007/s10615-020-00772-x
Berg, M. (1997). Problems and promises of the protocol. Social Science & Medicine, 44(8),1081-1088. https://doi.org/10.1016/s0277-9536(96)00235-3
Bergquist, M., & Rolandsson, B. (2022). Exploring ADM in clinical decision-making: Healthcare experts encountering digital automation. In S. Pink, M. Berg, D.
Lupton, & M. Ruckenstein (Eds.), Everyday automation: Experiencing and anticipating emerging technologies (pp. 31–58). Routledge. https://doi.org/10.4324/9781003170884
Berner, E. S., & La Lande, T. J. (2007). Overview of clinical decision support systems. In E. S. Berner (Ed.). Clinical decision support systems (pp. 3–22). Springer. https://doi.org/10.1007/978-0-387-38319-4_1
Bovens, M., & Zouridis, S. (2002). From street-level to system-level bureaucracies:
How information and communication technology is transforming administrative discretion and constitutional control. Public Administration Review, 62(2), 174–184. https://doi.org/10.1111/0033-3352.00168
Brante, T., Svensson, K., & Svensson, G. (2019). Ett professionellt landskap i förändring [A professional landscape in transition]. Studentlitteratur.
Brante, T., Johnsson, E. Olofsson, G., & Svensson, L. G. (2015). Professionerna i kunskapssamhället: En jämförande studie av svenska professioner [The professions in the knowledge society: A comparative study of Swedish professions]. Liber.
Charmaz, K. (2014). Grounded theory in global perspective: Reviews by international researchers. Qualitative Inquiry, 20(9), 1074–1084. https://doi.org/10.1177/1077800414545235
Daoud, A., & Puaca, G. (2011). An organic view of want formation: Pragmatic rationality, habitus and reflexivity. British Journal of Sociology of Education, 32(4), 603–622. https://doi.org/10.1080/01425692.2011.578440
Ebben, R. H., Vloet, L. C., Speijers, R. F., Tönjes, N. W., Loef, J., Pelgrim, T., & Berben, S. A. (2017). A patient-safety and professional perspective on non-conveyance in ambulance care: A systematic review. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 25, 1–20. https://doi.org/10.1186/s13049-017-0409-6
Eraut, M. (2004). Informal learning in the workplace. Studies in Continuing Education, 26(2), 247–273. https://doi.org/10.1080/158037042000225245
Evetts J. (2003). The sociological analysis of professionalism: Occupational change in the modern world. International Sociology, 18(2), 395–415. https://doi.org/10.1177/026858090301800200
Evetts, J. (2011). A new professionalism? Challenges and opportunities. Current Sociology, 59(4), 406–422. https://doi.org/10.1177/0011392111402585
Freidson, E. (2001). Professionalism, the third logic: On the practice of knowledge. University of Chicago Press.
Gadolin, C. (2018). Professional employees’ strategic employment of the managerial logic in healthcare. Qualitative Research in Organizations and Management: An International Journal, 13(2), 126-143. https://doi.org/10.1108/QROM-02-2016-1359
Gibbs, A. (2021). Focus groups and group interviews. In R. Coe, M. Waring, & L. V. Hedges (Eds.), Research methods and methodologies in education (pp. 240–247). Sage Publications.
Glaser, B. (1978). Theoretical sensitivity: Advances in the methodology of grounded theory. Sociology Press.
Gonzalez, A. S., & Burwood, S. (2003). Tacit knowledge and public accounts. Journal of Philosophy of Education, 37(3), 377–91. https://doi.org/10.1111/1467-9752.00334
Johansson, K., Denvall, V., & Vedung, E. (2015). After the NPM wave: Evidence-based practice and the vanishing client. Scandinavian Journal of Public Administration, 19(2), 69–88. https://doi.org/10.58235/sjpa.v19i2.15613
Hagiwara Anderson, M., Sjöqvist, BA., Lundberg, L., Suserud, B-O., Henricson, M., & Jonsson, A. (2012). Decision support system in prehospital care: A randomized controlled simulation study. American Journal of Emergency Medicine, 31, 145-153. https://doi.org/10.1016/j.ajem.2012.06.030
Khalifa, M., & Zabani, I. (2016). Improving utilization of clinical decision support systems by reducing alert fatigue: Strategies and recommendations. Studies in Health Technology and Informatics, 226, 51–54. https://doi.org/10.3233/978-1-61499-664-4-51
Klein, G. (1998). Sources of power: How people make decisions. MIT Press. https://doi.org/10.2307/j.ctt1v2xt08
Koufidis, C., Manninen, K., Nieminen, J., Wohlin, M., & Silén, C. (2020). Unraveling the polyphony in clinical reasoning research in medical education. Journal of Evaluation in Clinical Practice, 27(2), 438–450. https://doi.org/10.1111/jep.13432
Lave, J., & Wenger, E. (1991). Situated learning: Legitimate peripheral participation. Cambridge University Press. https://doi.org/10.1017/CBO9780511815355
Lessard C., Contandriopoulos A. P., & Beaulieu M. D. (2010). The role (or not) of economic evaluation at the micro level: Can Bourdieu’s theory provide a way forward for clinical decision-making?. Social Science & Medicine, 70(12), 1948–1956. https://doi.org/10.1016/j.socscimed.2010.03.013
Liljegren, A., & Parding, K. (2010). Ändrad styrning av välfärdsprofessioner: Exemplet evidensbasering i socialt arbete [Changed governance of welfare professions: The example of evidence-based practice in social work]. Socialvetenskaplig Tidskrift, 27(3–4), 270–288. https://doi.org/10.3384/SVT.2010.17.3-4.2474
Linde, S., & Svensson, K. (Eds.) (2021). Välfärdens aktörer Utmaningar för människor, professioner och organisationer [The Actors of Welfare: Challenges for Individuals, Professions, and Organizations]. Social Work Press. https://doi.org/10.37852/oblu.118
Noordegraaf, M. (2020). Protective or connective professionalism? How connected professionals can (still) act as autonomous and authoritative experts. Journal of Professions and Organization, 1(19), 205–223. https://doi.org/10.1093/jpo/joaa011
Ostropolets, A., Zhang, L. & Hripcsak, G. (2020). A scoping review of clinical decision support tools that generate new knowledge to support decision making in real time. Journal of American Medical Informatics Association, 27(12),1968–1976. https://doi.org/10.1093/jamia/ocaa200
Patterson, E. S., & Hoffman, R. R. (2012). Visualization framework of macrocognition functions. Cognition, Technology & Work, 14, 221–227. https://doi.org/10.1007/s10111-011-0208-1
Petrakaki, D., & Kornelakis, A. (2016). ‘We can only request what's in our protocol’: technology and work autonomy in healthcare. New Technology, Work and Employment, 31(3), 223–237. https://doi.org/10.1111/ntwe.12072
Ponnert, L., & Svensson, K. (2015). Standardisation—the end of professional discretion? European Journal of Social Work, 19(3–4), 586–599. https://doi.org/10.1080/13691457.2015.1074551
Puaca, G. (2013). Educational choices of the future: a sociological inquiry into micro-politics in education [Doctoral thesis, University of Gothenburg]. Gothenburg University Library. http://hdl.handle.net/2077/32782
Sayer, A. (2010). Bourdieu, ethics and practice. In A. Warde, & E. Silva (Eds.), Cultural analysis and the legacy of Bourdieu: Settling accounts and developing alternatives (pp. 87–101). Taylor & Francis. https://doi.org/10.4324/9780203878620
Sveriges Riksdag. (2018). Lag med kompletterande bestämmelser till EU:s dataskyddsförordning [Act with Supplementary Provisions to the EU General Data Protection Regulation] (SFS 2018:218). https://www.riksdagen.se/sv/dokument-och-lagar/dokument/svensk-forfattningssamling/lag-2018218-med-kompletterande-bestammelser_sfs-2018-218/
Sim, I., Gorman, P., Greenes, R. A., Haynes, B. R., Kaplan, B., Lehman, H., & Tang, P. C. (2001). Clinical decision support systems for the practice of evidence-based medicine. Journal of the American Medical Informatics Association, 8(6), 527–534. https://doi.org/10.1136/jamia.2001.0080527
Simonet, D. (2011). The new public management theory and the reform of European health care systems: An international comparative perspective. International Journal of Public Administration, 34(12), 815–826. https://doi.org/10.1080/01900692.2011.603401
Sutton, R. T., Pincock, D., Baumgart, D. C., Sadowski, D. C., Fedorak, R. N., & Kroeker, K. I. (2020). An overview of clinical decision support systems: Benefits, risks, and strategies for success. npj Digital Medicine, 3(17), 1–10. https://doi.org/10.1038/s41746-020-0221-y
Timmerman, S., & Epstein, S. (2010). A world of standards but not a standard world: Toward a sociology of standards and standardization. Annual Review of Sociology 36, 69–89. https://doi.org/10.1146/annurev.soc.012809.102629
Trowler, P., & Knight, P. T. (2000). Coming to know in higher education: Theorising faculty entry to new work contexts. Higher Education Research and Development, 19(1), 27–42. https://doi.org/10.1080/07294360050020453
Vetenskapsrådet. (2017). Forskningsetiska principer inom humanistisk-samhällsvetenskaplig forskning [Swedish Research Council’s guidelines for good research practice]. Retrieved from https://www.vr.se/download/18.68c009f71769c7698a41df/1610103120390/Forskningsetiska_principer_VR_2002.pdf
Wacquant, L. (2005). Habitus. In J. Beckert, & M. Zafirovski, (Eds.) International encyclopedia of economic sociology (pp. 315–319). Routledge. https://doi.org/10.4324/9780203824214
Wenger, E. (1998). Communities of practice: Learning, meaning, and identity. Cambridge University Press. https://doi.org/10.1017/CBO9780511803932
World Medical Association. (2013). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/
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