Complex Decision-Making in Clinical Practice

Clinical Decision Support (CDS) Systems are considered crucial for diagnosis, treatment and care of patients. However, practical benefits of such systems have been far below expectations. This paper explores how the evolving interdependencies in organizational, clinical, political, and behavioral terms influence the design and implementation of CDS. The paper discusses how these interdependencies complicate clinical use of CDS where cross-departmental patient pathways increasingly dominate approaches to dealing with patients with complex conditions. Empirically, we report from an acute geriatric patient pathway project. The aim was to design and implement a decision-support form for triage of elderly patients in the emergency unit. The study emphasizes the intertwined collaborative nature of healthcare work, and the resulting need to consider the whole context when designing and implementing CDS tools. The contribution is to emphasize the "extended design" perspective to capture how workplace technologies and practices are shaped across multiple contexts and prolonged periods.