Streamlining the Evidence‐to‐Practice Pathway With Computerised Decision Support in Anaesthesiology and Critical Care: A Qualitative Study of Clinician and System‐Level Interest Holder Perspectives Across Five Scandinavian Countries

BACKGROUND: Implementing evidence-based recommendations in anaesthesiology and critical care remains challenging due to guideline, workflow and contextual barriers. Guideline-based computerised clinical decision support systems (CDSS), embedded in structured pathways linking international guidelines to Scandinavian-endorsed recommendations and delivered via electronic health records, may help strengthen the evidence-to-practice pathway. This study aimed to explore perceived barriers and facilitators to their use. METHODS: This qualitative study interviewed 10 clinicians (anaesthesiologists and intensivists; specialists and non-specialists; < 40 and ≥ 40 years; male and female) and nine system-level stakeholders (hospital and health authority representatives) from Denmark, Finland, Iceland, Norway and Sweden. We integrated endorsed international guidelines into a CDSS providing patient-specific reminders linked to recommendations, as well as shared decision-making tools and decision-analytic components. Using a simulation application, participants explored the CDSS in a demo electronic health record. Through a framework analysis based on the GUIDES checklist, we categorised perspectives as barriers, facilitators or suggestions. RESULTS: Clinicians and system-level interest holders expressed broad interest in this multifunctional CDSS to support evidence-based, patient-centred care and appreciated the collaborative international pathway facilitated by digital tools. Key themes included the challenges hospitals face in translating international guidelines into up-to-date, locally adapted guidance. Artificial intelligence (AI) was perceived as having the potential to both enhance and challenge traditional CDSS. Opportunities were identified to strengthen shared decision-making for major decisions through the proposed system. Finally, participants highlighted the potential value of using a decision-analytic tool to prioritise reminders, although the tool was considered conceptually challenging in its current form and would require clearer presentation before being applied in CDSS. CONCLUSIONS: This prototype study indicates support for a multifunctional CDSS. Building on the barriers and facilitators identified in this study, interviewees advocated for real-world evaluation with particular attention to sustainable implementation. EDITORIAL COMMENT: This study aimed to describe how ICU clinicians experience interaction in a simulated electronic health record where there were chosen elements of decision support based on international treatment guidelines incorporated into the simulation. Participants were interviewed for their perceptions of what types of decision support might be most helpful to support their clinical work in future patient information and management systems.