Investigating Why Clinicians Deviate from Standards of Care: Liberating Patients from Mechanical Ventilation in the ICU

Clinical practice guidelines, care pathways, and protocols are designed tosupport evidence-based practices for clinicians; however, their adoptionremains a challenge. We set out to investigate why clinicians deviate from the“Wake Up and Breathe” protocol, an evidence-based guideline for liberatingpatients from mechanical ventilation in the intensive care unit (ICU). Weconducted over 40 hours of direct observations of live clinical workflows, 17interviews with frontline care providers, and 4 co-design workshops at threedifferent medical intensive care units. Our findings indicate that unlike priorliterature suggests, disagreement with the protocol is not a substantialbarrier to adoption. Instead, the uncertainty surrounding the application ofthe protocol for individual patients leads clinicians to deprioritize adoptionin favor of tasks where they have high certainty. Reflecting on these insights,we identify opportunities for technical systems to help clinicians ineffectively executing the protocol and discuss future directions for HCIresearch to support the integration of protocols into clinical practice incomplex, team-based healthcare settings.