Decision support in cardiac surgery: early exploration of requirements with cardiac anesthetists and surgeons

Successful implementation of clinical decision support tools is rare, the key barrier being the lack of user involvement during development. Following the idea, development, exploration, assessment, long-term follow-up (IDEAL) framework, this study aims to provide early insights into the current challenges, clinical processes, and priorities when developing new decision support tools in cardiac surgery. Using a qualitative approach, semi-structured interviews were conducted with cardiac anesthetists and surgeons from three Scottish cardiac centers. Thematic analysis identified adverse postoperative outcomes, ageing cardiac patient population and changing surgical procedures to be the main challenges in cardiac surgery. Existing risk prediction tools were largely not used due to a perceived lack of utility and validation. This study underscores the need to shift focus towards predicting postoperative complications, instead of mortality. It emphasizes the importance of early collaboration with clinical experts and stakeholders in developing decision support systems that are fit for purpose. By identifying the priorities of cardiac clinicians, the study lays the groundwork for developing clinically meaningful prediction models.