scholarly journals Improved preventive care clinical decision-making efficiency: leveraging a point-of-care clinical decision support system

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Scott Laing ◽  
Jay Mercer
Keyword(s):  
Decision Making ◽  
Electronic Medical Records ◽  
Preventive Care ◽  
Medical Records ◽  
Clinical Decision Making ◽  
Point Of Care ◽  
Clinical Decision ◽  
Ease Of Use ◽  
Perceived Usefulness ◽  
Digital Tools

Abstract Background Electronic medical records are widely used in family practices across Canada and can improve health outcomes. However, recent reports indicate that physicians using electronic medical records work longer and have less direct patient contact which may contribute to burnout. Therefore, new and innovative digital tools are essential to reduce physician workloads and improve patient-physician interaction to address physician burnout. The objective of this study was to assess the efficiency and accuracy of clinical decision-making when using a new preventive care point-of-care clinical decision support system (CDSS). An estimate of the potential annual time savings was also determined. This study also assessed physician reported perceived usefulness and ease of use of the CDSS. Methods Quantitative and qualitative data were collected during this study. Each participant evaluated two simulated patient charts and identified which preventive care metrics were due. The participants recorded their decisions and the time required to assess each chart. Participants then completed a Technology Acceptance Model survey regarding the perceived usefulness and ease of use of the CDSS, which included qualitative feedback. The amount of time saved was determined and participants’ clinical decision-making accuracy was scored against current Canadian preventive care guidelines. The number of preventive care specific visits completed per year was determined using clinic billing data. Results The preventive care CDSS saved an average of 195.7 s of chart review time (249.5 s vs 445.2 s; P < 0.001). A total of 1520 preventive visits were performed at Primrose and Bruyère Family Medicine Centres. Extrapolated across the organization, implementation of the new tool could save 82.6 h per year. Decision-making accuracy was not affected by the new tool (78.4% vs 80.9%, P > 0.05). Participants rated the perceived ease of use and usefulness to be very high. Conclusions New digital tools may reduce providers’ workload without impacting clinical decision-making accuracy. Participants indicated that the preventive care CDSS was useful and easy to use. Further software development and clinical studies are required to further improve and characterize the effect this new CDSS has when implemented in clinical practice.

POCT errors can lead to false potassium results

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Antonio Buño ◽  
Paloma Oliver
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Laboratory ◽  
Point Of Care ◽  
Clinical Intervention ◽  
Clinical Decision ◽  
Whole Process ◽  
Severe Hyperkalemia ◽  
Wrong Diagnosis ◽  
Critical Patients

Abstract Point-of-care-testing (POCT) facilitates rapid availability of results that allows prompt clinical decision making. These results must be reliable and the whole process must not compromise its quality. Blood gas analyzers are one of the most used methods for POCT tests in Emergency Departments (ED) and in critical patients. Whole blood is the preferred sample, and we must be aware that hemolysis can occur. These devices cannot detect the presence of hemolysis in the sample, and because of the characteristics of the sample, we cannot visually detect it either. Hemolysis can alter the result of different parameters, including potassium with abnormal high results or masking low levels (hypokalemia) when reporting normal concentrations. Severe hyperkalemia is associated with the risk of potentially fatal cardiac arrhythmia and demands emergency clinical intervention. Hemolysis can be considered the most frequent cause of pseudohyperkalemia (spurious hyperkalemia) or pseudonormokalemia and can be accompanied by a wrong diagnosis and an ensuing inappropriate clinical decision making. A complete review of the potential causes of falsely elevated potassium concentrations in blood is presented in this article. POCT programs properly led and organized by the clinical laboratory can help to prevent errors and their impact on patient care.

The Use of Artificial Intelligence Systems for Support of Medical Decision-Making

2011 ◽  
pp. 1017-1029
Author(s):  
William Claster ◽  
Nader Ghotbi ◽  
Subana Shanmuganathan
Keyword(s):  
Artificial Intelligence ◽  
Decision Making ◽  
Statistical Analysis ◽  
Medical Records ◽  
Clinical Decision Making ◽  
Ct Scanning ◽  
Clinical Decision ◽  
Radiology Department ◽  
Self Organizing Map ◽  
One Year

There is a treasure trove of hidden information in the textual and narrative data of medical records that can be deciphered by text-mining techniques. The information provided by these methods can provide a basis for medical artificial intelligence and help support or improve clinical decision making by medical doctors. In this paper we extend previous work in an effort to extract meaningful information from free text medical records. We discuss a methodology for the analysis of medical records using some statistical analysis and the Kohonen Self-Organizing Map (SOM). The medical data derive from about 700 pediatric patients’ radiology department records where CT (Computed Tomography) scanning was used as part of a diagnostic exploration. The patients underwent CT scanning (single and multiple) throughout a one-year period in 2004 at the Nagasaki University Medical Hospital. Our approach led to a model based on SOM clusters and statistical analysis which may suggest a strategy for limiting CT scan requests. This is important because radiation at levels ordinarily used for CT scanning may pose significant health risks especially to children.

Point of Care Ultrasound in Geriatric Patients: Prospective Evaluation of a Portable Handheld Ultrasound Device

2019 ◽  
Vol 41 (03) ◽  
pp. 308-316 ◽  
Author(s):  
Eckhart Fröhlich ◽  
Katharina Beller ◽  
Reinhold Muller ◽  
Maria Herrmann ◽  
Ines Debove ◽  
...  
Keyword(s):  
Decision Making ◽  
Geriatric Patients ◽  
Clinical Decision Making ◽  
Point Of Care ◽  
False Negative ◽  
Clinical Decision ◽  
Point Of Care Ultrasound ◽  
Handheld Device ◽  
Ultrasound Device ◽  
Handheld Ultrasound

Abstract Purpose The aim of the current study was to evaluate point of care ultrasound (POCUS) in geriatric patients by echoscopy using a handheld ultrasound device (HHUSD, VScan) at bedside in comparison to a high-end ultrasound system (HEUS) as the gold standard. Materials and Methods Prospective observational study with a total of 112 geriatric patients. The ultrasound examinations were independently performed by two experienced blinded examiners with a portable handheld device and a high-end ultrasound device. The findings were compared with respect to diagnostic findings and therapeutic implications. Results The main indications for the ultrasound examinations were dyspnea (44.6 %), fall (frailty) (24.1 %) and fever (21.4 %). The most frequently found diagnoses were cystic lesions 32.1 % (35/109), hepatic vein congestion 19.3 % (21/109) and ascites 13.6 % (15/110). HHUSD delivered 13 false-negative findings in the abdomen resulting in an “overall sensitivity” of 89.5 %. The respective “overall specificity” was 99.6 % (7 false-positive diagnoses). HHUSD (versus HEUS data) resulted in 13.6 % (17.3 %) diagnostically relevant procedures in the abdomen and 0.9 % (0.9 %) in the thorax. Without HHUSD (HEUS) 95.7 % (100 %) of important pathological findings would have been missed. Conclusion The small HHUSD tool improves clinical decision-making in immobile geriatric patients at the point of care (geriatric ward). In most cases, HHUSD allows sufficiently accurate yes/no diagnoses already at the bedside, thereby clarifying the leading symptoms for early clinical decision-making.

scholarly journals Factors affecting clinical decision-making in inflammatory bowel disease and the role of point-of-care calprotectin

2018 ◽  
Vol 11 ◽  
pp. 1756283X1774473 ◽  
Author(s):  
Yannick Derwa ◽  
Christopher J.M. Williams ◽  
Ruchit Sood ◽  
Saqib Mumtaz ◽  
M. Hassan Bholah ◽  
...  
Keyword(s):  
Decision Making ◽  
Inflammatory Bowel Disease ◽  
Disease Activity ◽  
Medical Therapy ◽  
Bowel Disease ◽  
Clinical Decision Making ◽  
Point Of Care ◽  
Clinical Decision ◽  
Mucosal Inflammation ◽  
Inflammatory Bowel

Objectives: Patient-reported symptoms correlate poorly with mucosal inflammation. Clinical decision-making may, therefore, not be based on objective evidence of disease activity. We conducted a study to determine factors associated with clinical decision-making in a secondary care inflammatory bowel disease (IBD) population, using a cross-sectional design. Methods: Decisions to request investigations or escalate medical therapy were recorded from outpatient clinic encounters in a cohort of 276 patients with ulcerative colitis (UC) or Crohn’s disease (CD). Disease activity was assessed using clinical indices, self-reported flare and faecal calprotectin ≥ 250 µg/g. Demographic, disease-related and psychological factors were assessed using validated questionnaires. Logistic regression was performed to determine the association between clinical decision-making and symptoms, mucosal inflammation and psychological comorbidity. Results: Self-reported flare was associated with requesting investigations in CD [odds ratio (OR) 5.57; 95% confidence interval (CI) 1.84–17.0] and UC (OR 10.8; 95% CI 1.8–64.3), but mucosal inflammation was not (OR 1.62; 95% CI 0.49–5.39; and OR 0.21; 95% CI 0.21–1.05, respectively). Self-reported flare (OR 7.96; 95% CI 1.84–34.4), but not mucosal inflammation (OR 1.67; 95% CI 0.46–6.13) in CD, and clinical disease activity (OR 10.36; 95% CI 2.47–43.5) and mucosal inflammation (OR 4.26; 95% CI 1.28–14.2) in UC were associated with escalation of medical therapy. Almost 60% of patients referred for investigation had no evidence of mucosal inflammation. Conclusions: Apart from escalation of medical therapy in UC, clinical decision-making was not associated with mucosal inflammation in IBD. The use of point-of-care calprotectin testing may aid clinical decision-making, improve resource allocation and reduce costs in IBD.

Point-of-Care Creatinine to Assist Clinical Decision Making in Suspected Sepsis in the Community

2019 ◽  
Vol 18 (2) ◽  
pp. 41-45
Author(s):  
Susan Simpson ◽  
Joshua Storrar ◽  
James Ritchie ◽  
Khalid Alshawy ◽  
Leonard Ebah ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Point Of Care ◽  
Clinical Decision ◽  
Suspected Sepsis

scholarly journals Perception and Usage of Point of Care Devices: A Cross-sectional Study Targeting Residents and Trainers in Oman

2021 ◽  
Vol 36 (1) ◽  
pp. e213-e213
Author(s):  
Amna Al Harrasi ◽  
Laila Mohammed Al Mbeihsi ◽  
Abdulhakeem Al Rawahi ◽  
Mohammed Al Shafaee
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Point Of Care ◽  
Clinical Decision ◽  
Cross Sectional Study ◽  
Mobile Technologies ◽  
Handheld Devices ◽  
Sectional Study ◽  
Cross Sectional ◽  
The Impact

Objectives: The use of mobile technologies and handheld computers by physicians has increased worldwide. However, there are limited studies globally regarding training physicians on the use of such devices in clinical practice. In addition, no studies have been conducted previously in Oman addressing this issue among postgraduate medical trainees and trainers. The present study explores the practice and perception of resident doctors and trainers towards the use of mobile technologies and handheld devices in healthcare settings in Oman. Methods: This cross-sectional study was conducted using a validated questionnaire disseminated via email to all residents and trainers in five major training programs of the Oman Medical Specialty Board (OMSB). The questionnaire explored three main areas; perception, usage, and perceived barriers of handheld devices. Results: Overall, 61.4% of the residents and 28.3% of the trainers responded to the questionnaire. Both types of participants agreed that the use of such devices positively affects clinical decision-making. In total, 98.8% of the participating residents and 86.7% of the trainers frequently used handheld devices. Both OMSB residents and trainers agreed that lack of time, training, and applications were the most common factors limiting the use of these devices. Participants emphasized the need for constructive training regarding the use of handheld devices as healthcare resources. Conclusions: Point-of-care devices are positively perceived and frequently used by OMSB trainees and trainers. However, constructive training on the effective usage of these devices in clinical decision-making is needed. Further future studies to evaluate the impact of using such devices in patient care should be conducted.

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