scholarly journals Quality initiative to improve emergency department sepsis bundle compliance through utilisation of an electronic health record tool

2022 ◽  
Vol 11 (1) ◽  
pp. e001624
Author(s):  
Nicholus Michael Warstadt ◽  
J Reed Caldwell ◽  
Nicole Tang ◽  
Staci Mandola ◽  
Catherine Jamin ◽  
...  
Keyword(s):  
Emergency Department ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Electronic Health Record ◽  
Health Record ◽  
Intention To Treat ◽  
Significant Difference ◽  
Bundle Compliance ◽  
Electronic Health ◽  
Sepsis Bundle

IntroductionSepsis is a common cause of emergency department (ED) presentation and hospital admission, accounting for a disproportionate number of deaths each year relative to its incidence. Sepsis outcomes have improved with increased recognition and treatment standards promoted by the Surviving Sepsis Campaign. Due to delay in recognition and other barriers, sepsis bundle compliance remains low nationally. We hypothesised that a targeted education intervention regarding use of an electronic health record (EHR) tool for identification and management of sepsis would lead to increased EHR tool utilisation and increased sepsis bundle compliance.MethodsWe created a multidisciplinary quality improvement team to provide training and feedback on EHR tool utilisation within our ED. A prospective evaluation of the rate of EHR tool utilisation was monitored from June through December 2020. Simultaneously, we conducted two retrospective cohort studies comparing overall sepsis bundle compliance for patients when EHR tool was used versus not used. The first cohort was all patients with intention-to-treat for any sepsis severity. The second cohort of patients included adult patients with time of recognition of sepsis in the ED admitted with a diagnosis of severe sepsis or septic shock.ResultsEHR tool utilisation increased from 23.3% baseline prior to intervention to 87.2% during the study. In the intention-to-treat cohort, there was a statistically significant difference in compliance between EHR tool utilisation versus no utilisation in overall bundle compliance (p<0.001) and for several individual components: initial lactate (p=0.009), repeat lactate (p=0.001), timely antibiotics (p=0.031), blood cultures before antibiotics (p=0.001), initial fluid bolus (p<0.001) and fluid reassessment (p<0.001). In the severe sepsis and septic shock cohort, EHR tool use increased from 71.2% pre-intervention to 85.0% post-intervention (p=0.008).ConclusionWith training, feedback and EHR optimisation, an EHR tool can be successfully integrated into current workflows and appears to increase sepsis bundle compliance.

scholarly journals Electronic health record-based clinical decision support alert for severe sepsis: a randomised evaluation

2019 ◽  
Vol 28 (9) ◽  
pp. 762-768 ◽  
Author(s):  
Norman Lance Downing ◽  
Joshua Rolnick ◽  
Sarah F Poole ◽  
Evan Hall ◽  
Alexander J Wessels ◽  
...  
Keyword(s):  
Severe Sepsis ◽  
Decision Support ◽  
Electronic Health Record ◽  
Clinical Decision Support ◽  
Tertiary Care ◽  
Clinical Decision ◽  
Health Record ◽  
Hospitalised Patients ◽  
Significant Difference ◽  
Electronic Health

BackgroundSepsis remains the top cause of morbidity and mortality of hospitalised patients despite concerted efforts. Clinical decision support for sepsis has shown mixed results reflecting heterogeneous populations, methodologies and interventions.ObjectivesTo determine whether the addition of a real-time electronic health record (EHR)-based clinical decision support alert improves adherence to treatment guidelines and clinical outcomes in hospitalised patients with suspected severe sepsis.DesignPatient-level randomisation, single blinded.SettingMedical and surgical inpatient units of an academic, tertiary care medical centre.Patients1123 adults over the age of 18 admitted to inpatient wards (intensive care units (ICU) excluded) at an academic teaching hospital between November 2014 and March 2015.InterventionsPatients were randomised to either usual care or the addition of an EHR-generated alert in response to a set of modified severe sepsis criteria that included vital signs, laboratory values and physician orders.Measurements and main resultsThere was no significant difference between the intervention and control groups in primary outcome of the percentage of patients with new antibiotic orders at 3 hours after the alert (35% vs 37%, p=0.53). There was no difference in secondary outcomes of in-hospital mortality at 30 days, length of stay greater than 72 hours, rate of transfer to ICU within 48 hours of alert, or proportion of patients receiving at least 30 mL/kg of intravenous fluids.ConclusionsAn EHR-based severe sepsis alert did not result in a statistically significant improvement in several sepsis treatment performance measures.

scholarly journals Efficiency and Economic Benefits of a Payer-based Electronic Health Record in an Emergency Department

2010 ◽  
Vol 17 (8) ◽  
pp. 824-833 ◽  
Author(s):  
Gregory W. Daniel ◽  
Edward Ewen ◽  
Vincent J. Willey ◽  
Charles L. Reese IV ◽  
Farshad Shirazi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Electronic Health Record ◽  
Economic Benefits ◽  
Health Record ◽  
Electronic Health

Electronic Health Record–Assisted Reflex Urine Culture Testing Improves Emergency Department Diagnostic Efficiency

2019 ◽  
Vol 35 (3) ◽  
pp. 252-257 ◽  
Author(s):  
Ryan F. Coughlin ◽  
David Peaper ◽  
Craig Rothenberg ◽  
Marjorie Golden ◽  
Marie-Louise Landry ◽  
...  
Keyword(s):  
Emergency Department ◽  
Decision Support ◽  
Electronic Health Record ◽  
Urine Culture ◽  
Diagnostic Yield ◽  
Secondary Outcome ◽  
Health Record ◽  
Diagnostic Efficiency ◽  
Ed Visits ◽  
Electronic Health

The authors evaluated the effectiveness of an electronic health record (EHR)-based reflex urine culture testing algorithm on urine test utilization and diagnostic yield in the emergency department (ED). The study implemented a reflex urine culture order with EHR decision support. The primary outcome was the number of urine culture orders per 100 ED visits. The secondary outcome was the diagnostic yield of urine cultures. After the intervention, the mean number of urine cultures ordered was 5.95 fewer per 100 ED visits (9.3 vs 15.2), and there was a decrease in normal, or negative, cultures by 2.42 per 100 ED visits. There also was a statistically significant decrease in urine culture utilization and an increase in the positive proportion of cultures. Simple EHR clinical decision-support tools along with reflex urine culture testing can significantly reduce the number of urine cultures performed while improving diagnostic yield in the ED.

scholarly journals Potential of an Electronic Health Record-Integrated Patient Portal for Improving Care Plan Concordance during Acute Care

2019 ◽  
Vol 10 (03) ◽  
pp. 358-366 ◽  
Author(s):  
Anuj K. Dalal ◽  
Patricia Dykes ◽  
Lipika Samal ◽  
Kelly McNally ◽  
Eli Mlaver ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Acute Care ◽  
Transitions Of Care ◽  
Care Plan ◽  
Health Record ◽  
Patient Portal ◽  
Intention To Treat ◽  
Electronic Health ◽  
The Impact ◽  
Treat Analysis

Background Care plan concordance among patients and clinicians during hospitalization is suboptimal. Objective This article determines whether an electronic health record (EHR)-integrated patient portal was associated with increased understanding of the care plan, including the key recovery goal, among patients and clinicians in acute care setting. Methods The intervention included (1) a patient portal configured to solicit a single patient-designated recovery goal and display the care plan from the EHR for participating patients; and (2) an electronic care plan for all unit-based nurses that displays patient-inputted information, accessible to all clinicians via the EHR. Patients admitted to an oncology unit, including their nurses and physicians, were enrolled before and after implementation. Main outcomes included mean concordance scores for the overall care plan and individual care plan elements. Results Of 457 and 283 eligible patients approached during pre- and postintervention periods, 55 and 46 participated in interviews, respectively, including their clinicians. Of 46 postintervention patients, 27 (58.7%) enrolled in the patient portal. The intention-to-treat analysis demonstrated a nonsignificant increase in the mean concordance score for the overall care plan (62.0–67.1, adjusted p = 0.13), and significant increases in mean concordance scores for the recovery goal (30.3–57.7, adjusted p < 0.01) and main reason for hospitalization (58.6–79.2, adjusted p < 0.01). The on-treatment analysis of patient portal enrollees demonstrated significant increases in mean concordance scores for the overall care plan (61.9–70.0, adjusted p < 0.01), the recovery goal (30.4–66.8, adjusted p < 0.01), and main reason for hospitalization (58.3–81.7, adjusted p < 0.01), comparable to the intention-to-treat analysis. Conclusion Implementation of an EHR-integrated patient portal was associated with increased concordance for key care plan components. Future efforts should be directed at improving concordance for other care plan components and conducting larger, randomized studies to evaluate the impact on key outcomes during transitions of care. Clinical Trials Identifier NCT02258594.

65 EMF The Impact of Electronic Health Record Implementation on Emergency Department Operations

2012 ◽  
Vol 60 (4) ◽  
pp. S25 ◽  
Author(s):  
M.J. Ward ◽  
C. Froehle ◽  
K.W. Hart ◽  
S.P. Collins ◽  
C.J. Lindsell
Keyword(s):  
Emergency Department ◽  
Electronic Health Record ◽  
Health Record ◽  
Electronic Health ◽  
The Impact
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