Lost in Translation: Factors Influencing Successful Implementation of Evidence-Based Guidelines into Clinical Decision Support

2018 ◽  
Vol 7 (1) ◽  
pp. 92-92
Author(s):  
Christopher Saikalis ◽  
Danielle Weldon ◽  
Rebecca Kowalski ◽  
Kristen Miller
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Successful Implementation ◽  
Evidence Based ◽  
Translation Factors ◽  
Factors Influencing ◽  
Evidence Based Guidelines ◽  
Lost In Translation

scholarly journals 978. Assessing the Impact of a Mobile Device-Based Clinical Decision Support Tool on Guideline Adherence and Mental Workload

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S40-S40
Author(s):  
Katherine Richardson ◽  
Sarah Fouquet ◽  
Ellen Kerns ◽  
Russell Mcculloh
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Mental Workload ◽  
Clinical Decision ◽  
Medical Decision ◽  
Evidence Based ◽  
System Usability Scale ◽  
Nasa Tlx ◽  
Evidence Based Guidelines ◽  
The Impact

Abstract Background Fever in infants <90 days old can indicate a serious bacterial infection (SBI) such as urinary tract infection, bacteremia, or meningitis. Clinical management of febrile infants varies widely. Implementing clinical practice guidelines (CPGs) can help standardize care, and electronic clinical decision support (eCDS) tools are a potential means of distributing CPGs. Little is known regarding the individual-level impact of eCDS tool use on medical decision-making. Children’s Mercy Kansas City developed a mobile eCDS tool (CMPeDS: Pediatric Decision Support) that was used internationally in a practice standardization project focused on the management of febrile infants. Methods We conducted a prospective cross-over simulation study amongst pediatric healthcare providers. Attending and resident physicians performed simulated patient scenarios using either CMPeDS or a standard text reference (the Harriet Lane Handbook). Participants’ responses in the simulation were evaluated based on adherence to evidence-based guidelines. Participants’ mental workload was assessed using the NASA Task Load Index survey (NASA-TLX, in which lower scores are optimal) to assesses mental, physical, and temporal demand, as well as performance, effort, and frustration when completing a series of tasks. Paired t-test and ANOVA were used to determine significance for case performance scores and NASA-TLX scores, respectively. A System Usability Scale (SUS) was used to determine usability of the CMPeDS app. Results A total 28 of 32 planned participants have completed trial procedures to date. Mean performance scores on the cases were significantly higher with CMPeDS vs. standard reference, (87.7% vs. 72.4% [t(27) 3.22, P = 0.003]). Participants reported lower scores on the NASA-TLX when using CMPeDS compared with standard reference tool (Figure 1). Mean score on SUS was 88.2 (scale 0–100) indicating excellent tool usability (Figure 2). Conclusion Using the eCDS tool CMPeDS was associated with significantly increased adherence to evidence-based guidelines for febrile infant management and decreased mental workload in simulation. Our findings highlight the potential value of eCDS deployment as part of CPG implementation projects. Disclosures All authors: No reported disclosures.

Computerized Clinical Decision Support: A Technology to Implement and Validate Evidence Based Guidelines

2008 ◽  
Vol 64 (2) ◽  
pp. 520-537 ◽  
Author(s):  
Joseph F. Sucher ◽  
Frederick A. Moore ◽  
S Rob Todd ◽  
R Matthew Sailors ◽  
Bruce A. McKinley
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Evidence Based ◽  
Evidence Based Guidelines

Clinical Decision Support System Adoption & Implementation in African Health Systems: A SWOT Analysis. (Preprint)

2021 ◽  
Author(s):  
Victoria Oluwafunmilola Kolawole
Keyword(s):  
Developing Countries ◽  
Decision Support ◽  
Health Systems ◽  
Clinical Decision Support ◽  
Clinical Decision Support System ◽  
Swot Analysis ◽  
Clinical Decision ◽  
Developed Countries ◽  
Evidence Based ◽  
African Health

BACKGROUND The clinical decision support system (CDSS) has been an important achievement of health technology in the 21st century. In developed countries, it has transformed the way health services are being delivered and has shown to be a tool that reduces medical errors and misdiagnoses in Healthcare. However, CDSS remains underutilized in developing countries in Africa. OBJECTIVE This study aims to review the literature to improve our understanding of the “strengths, weaknesses, opportunities and threats (SWOT)” associated with CDSS implementation in African health systems. METHODS This study included a literature review conducted in PubMed with a total of 19 articles between the year 2010 to date (past 10years) reviewed for key themes and categorized into one of 4 possible areas within the SWOT analysis. RESULTS Articles reviewed showed common strengths of efficiency at the workplace, Improved healthcare quality, benefits in developed countries, good examples of evidence-based decision making. unreliable electric power supply, inconsistent Internet connectivity, clinician's limited computer skills, and lack of enough published evidence of benefits in developing countries are listed as a weakness. The opportunities are high demand for evidence-based practice in healthcare, a strong demand for quality healthcare, growing interest to use modern technologies. The common threats identified are government policy, political instability, low funding and resistance of use by providers. CONCLUSIONS There’s the need to work on the technical, organizational and financial barriers to ensure high adoption and implementation of the CDSS in African Health systems. Also, the lag on the knowledge available on its impact in developing countries must be worked on by supporting more studies to add to the body of knowledge.

Face-to-Face: Resident-led Radiology Medicine Rounds Facilitate Evidence-based Processes for Clinical Decision Support

2020 ◽  
Author(s):  
Adam E. Goldman-Yassen ◽  
Sara B. Strauss ◽  
Peter P. Vlismas ◽  
Anand D. Jagannath ◽  
Marshall Yuan ◽  
...  
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Evidence Based ◽  
Face To Face

scholarly journals Understanding Why Clinicians Answer or Ignore Clinical Decision Support Prompts

2012 ◽  
Vol 03 (03) ◽  
pp. 309-317 ◽  
Author(s):  
V. Anand ◽  
S. M. Downs ◽  
A.E. Carroll
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
Health Improvement ◽  
Key Factors ◽  
Factors Influencing ◽  
Number Of Factors ◽  
Computer Automation ◽  
Computer Decision Support

Summary Introduction: The identification of key factors influencing responses to prompts and reminders within a computer decision support system (CDSS) has not been widely studied. The aim of this study was to evaluate why clinicians routinely answer certain prompts while others are ignored. Methods: We utilized data collected from a CDSS developed by our research group – the Child Health Improvement through Computer Automation (CHICA) system. The main outcome of interest was whether a clinician responded to a prompt. Results: This study found that, as expected, some clinics and physicians were more likely to address prompts than others. However, we also found clinicians are more likely to address prompts for younger patients and when the prompts address more serious issues. The most striking finding was that the position of a prompt was a significant predictor of the likelihood of the prompt being addressed, even after controlling for other factors. Prompts at the top of the page were significantly more likely to be answered than the ones on the bottom. Conclusions: This study detailed a number of factors that are associated with physicians following clinical decision support prompts. This information could be instrumental in designing better interventions and more successful clinical decision support systems in the future.

scholarly journals The Use of Evidence-Based, Problem-Oriented Templates as a Clinical Decision Support in an Inpatient Electronic Health Record System

2016 ◽  
Vol 07 (03) ◽  
pp. 790-802 ◽  
Author(s):  
Nila Radhakrishnan ◽  
Carrie Warring ◽  
Ankur Jain ◽  
Jorge Fuentes ◽  
Angela Dolganiuc ◽  
...  
Keyword(s):  
Decision Support ◽  
Electronic Health Record ◽  
Clinical Decision Support ◽  
Outcome Measurement ◽  
Clinical Decision ◽  
Electronic Health Record System ◽  
Evidence Based ◽  
Health Record ◽  
Record System ◽  
Electronic Health

SummaryThe integration of clinical decision support (CDS) in documentation practices remains limited due to obstacles in provider workflows and design restrictions in electronic health records (EHRs). The use of electronic problem-oriented templates (POTs) as a CDS has been previously discussed but not widely studied.We evaluated the voluntary use of evidence-based POTs as a CDS on documentation practices.This was a randomized cohort (before and after) study of Hospitalist Attendings in an Academic Medical Center using EPIC EHRs. Primary Outcome measurement was note quality, assessed by the 9-item Physician Documentation Quality Instrument (PDQI-9). Secondary Outcome measurement was physician efficiency, assessed by the total charting time per note.Use of POTs increased the quality of note documentation [score 37.5 vs. 39.0, P = 0.0020]. The benefits of POTs scaled with use; the greatest improvement in note quality was found in notes using three or more POTs [score 40.2, P = 0.0262]. There was no significant difference in total charting time [30 minutes vs. 27 minutes, P = 0.42].Use of evidence-based and problem-oriented templates is associated with improved note quality without significant change in total charting time. It can be used as an effective CDS during note documentation. Citation: Mehta R, Radhakrishnan NS, Warring CD, Jain A, Fuentes J, Dolganiuc A, Lourdes LS, Busigin J, Leverence RR. The use of evidence-based, problemoriented templates as a clinical decision support in an inpatient electronic health record system.

Sign in / Sign up

Export Citation Format

Share Document