Table 1.

Factors impacting clinicians’ CDS^a use identified through academic detailing and clinician education done during academic detailing interviews. Positive and negative factors are indicated by the +, +/–, and – symbols.

Categories of factors impacting clinicians’ CDS use through academic detailing	Factors impacting clinicians’ CDS use identified through academic detailing	Clinician education done during academic detailing interviews
Aspects of the CDS tool’s design	[+] CDS is simple. [+] CDS requires minimal input from the clinician. [+] CDS automatically identifies a high-risk patient and prompts care that the clinician would not otherwise have considered. [+/–] CDS enforces a hard stop in the clinician’s workflow. [+/–] CDS alert fires while the clinician is completing discharge in the EHRb.	Discussed why the CDS alert fires when it does and the potential benefits and challenges of it firing at a different point in the clinician’s workflow.
Clinicians’ understanding of the CDS or referral process	[–] Clinician confuses the geriatric mobility and falls clinic with the faint and falls clinic. [–] Clinician believes only patients being seen for a fall are appropriate referrals. [–] Clinician believes referring the patient will be cumbersome, ie, require written justification. [+] Clinician is familiar with the concept of the CDS from an organizational stakeholder’s communication.	Clarified which clinic the referral goes to. Clarified that referral is appropriate preventative care for patients regardless of their presenting problem. Demonstrated how simple and quick it is to place a referral via the CDS.
Busy nature of the EDc environment	[+/–] A busy ED environment.
Clinicians’ perceptions of the patient and their associated fall risk	[+/–] Clinicians’ agreement with the CDS’s assessment of the patient’s fall risk. [–] Clinicians’ perception of the patient’s openness to, need for, or benefit from the intervention.	Demonstrated where in the CDS to find the reasons the patient is being flagged as high risk. Stressed the potential benefits of a successful referral for both the patient and health system.
Opacity of the referral process	[–] Clinicians lack clarity on where the referral goes once it is sent. [–] Clinicians are uncertain about who should communicate with the patient about the referral, ie, themselves or a nurse. [+/–] Clinicians (do not) have the information necessary for counseling patients on what to expect from the referral and why they are being referred.	Clarified which clinic the referral goes to. Clarified the importance of counseling patients on the referral and demonstrated where in the CDS to access information to support counseling patients on the referral. Demonstrated where in the CDS to find the reasons the patient was flagged as high risk.

^aCDS: clinical decision support.

^bEHR: electronic health record.

^cED: emergency department.