scholarly journals Quality of the documentation of the Nursing process in clinical decision support systems

2021 ◽  
Vol 29 ◽  
Author(s):  
Neurilene Batista de Oliveira ◽  
Heloísa Helena Ciqueto Peres
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
P Value ◽  
Nursing Process ◽  
Post Intervention ◽  
Quasi Experimental ◽  
Process Documentation

Objective: to compare the quality of the Nursing process documentation in two versions of a clinical decision support system. Method: a quantitative and quasi-experimental study of the before-and-after type. The instrument used to measure the quality of the records was the Brazilian version of the Quality of Diagnoses, Interventions and Outcomes, which has four domains and a maximum score of 58 points. A total of 81 records were evaluated in version I (pre-intervention), as well as 58 records in version II (post-intervention), and the scores obtained in the two applications were compared. The interventions consisted of planning, pilot implementation of version II of the system, training and monitoring of users. The data were analyzed in the R software, using descriptive and inferential statistics. Results: the mean obtained at the pre-intervention moment was 38.24 and, after the intervention, 46.35 points. There was evidence of statistical difference between the means of the pre- and post-intervention groups, since the p-value was below 0.001 in the four domains evaluated. Conclusion: the quality of the documentation of the Nursing process in version II of the system was superior to version I. The efficacy of the system and the effectiveness of the interventions were verified. This study can contribute to the quality of documentation, care management, visibility of nursing actions and patient safety.

scholarly journals Effect of Web-based Clinical Decision Support Systems on Adherence to Venous Thromboembolism Prophylaxis guideline among ICU Nonsurgical Patients: A Prospective Before and After Study

2021 ◽  
Author(s):  
Mehrdad Karajizadeh ◽  
Farid Zand ◽  
Roxana Sharifian ◽  
Afsaneh Vazin ◽  
Najmeh Bayati
Keyword(s):  
Decision Support ◽  
Venous Thromboembolism ◽  
Decision Support Systems ◽  
Clinical Decision Support ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
P Value ◽  
Post Intervention ◽  
Vte Prophylaxis ◽  
Nonsurgical Patients

Abstract Background and objective: There is a gap between expert recommendations and clinical practice in (Venous Thromboembolism) VTE prophylaxis among nonsurgical patients worldwide. Rate of adherence to evidence-based practice is inadequate in the nonsurgical population. Therefore, this study aimed to determine The effect of Clinical Decision Support Systems(CDSS) on the use of the appropriate VTE Prophylaxis in Nonsurgical Patients in the Intensive Care Unit (ICU).Method: We conducted a cross-sectional study (pre and post-implementation CDSS for recommendation VTE prophylaxis order set) to analyze the effect of the CDSS within CPOE on the appropriate VTE prophylaxis in three ICUs of the Nemazee hospital (before intervention from 20 April 2020, to 21 November 2020 and post-intervention duration form 7 April 2021, to 9 July 2021). The pre-intervention and post-intervention phase samples comprised 175 and 27 patients, respectively. P-value is less than 0.05 was considered a significant level. All statistical analysis was performed by SPSS version 24.Results: Adherence to VTE prophylaxis guidelines after introduced CDSS for recommendation VTE prophylaxis within CPOE system in nonsurgical patients in ICUs increase from 48.6% to 77.8% (p-value<01). However, mortality rate (pre-intervention 13.80% vs post-intervention 14.80%(p-value=0.88)) and means of length of stay (pre-intervention 13.66 vs post intervention13.63(p-value=0.49)) in ICU have not significantly change after introduced CDSS for recommendation VTE prophylaxis order sets.Conclusion: The results indicate that the CDSS for recommendation VTE prophylaxis within CPOE improves adherence to VTE prophylaxis in nonsurgical patients at ICUs, which assist provider to select the most tailored VTE prophylaxis. Further study needs to evaluate implemented CDSS for recommendation VTE prophylaxis in nonsurgical patients at a province and national level.

scholarly journals Integrating Artifact Detection with Clinical Decision Support Systems (Preprint)

2020 ◽  
Author(s):  
Shermeen Nizami ◽  
Carolyn McGregor ◽  
James Robert Green
Keyword(s):  
Critical Care ◽  
Decision Support ◽  
Real Time ◽  
Clinical Decision Support ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
Signal Quality ◽  
Artifact Detection ◽  
Physiologic Data

BACKGROUND Clinical decision support systems (CDSS) have the potential to lower patient mortality and morbidity rates. However, signal artifacts present in physiologic data affect the reliability and accuracy of CDSS. Moreover, patient monitors and other medical devices generate false alarms while processing artifactual data. This leads to alarm fatigue due to increased noise levels, staff disruption, and staff desensitization in busy critical care environments. Thereby, adversely affecting the quality of care at the patient bedside. Hence, artifact detection (AD) algorithms play a crucial role in assessing the quality of physiologic data and mitigating the impact of these artifacts. OBJECTIVE Recently, we developed a novel AD framework for integrating AD algorithms with CDSS. The framework was designed with features to support real-time implementation within critical care. In this research, we evaluate the framework and its features in a false alarm reduction study. We develop static framework component models followed by dynamic framework compositions to formulate four CDSS. We evaluate these formulations using neonatal patient data, and validate the six framework features of flexibility, reusability, signal quality indicator standardization, scalability, customizability, and real-time implementation support. METHODS We develop four exemplar static AD components with standardized requirements and provisions interfaces facilitating interoperability of framework components. These AD components are mixed and matched into four different AD compositions to mitigate artifacts. Each AD composition is integrated with a novel static clinical event detection (CED) component to formulate and evaluate dynamic CDSS for arterial oxygen saturation (SpO2) alarms generation. RESULTS With a sensitivity of 80%, the lowest achievable SpO2 false alarm rate is 39%. This demonstrates the utility of the framework in identifying the optimal dynamic composition to serve a given clinical need. CONCLUSIONS The framework features including reusability, signal quality indicator standardization, scalability, and customizability allow for novel CDSS formulations to be evaluated and compared. The optimal solution for a CDSS can then be hard-coded and integrated within clinical workflows for real-time implementation. Flexibility to serve different clinical needs and standardized component interoperability of the framework support the potential for real-time clinical implementation of AD.

scholarly journals Effectiveness of clinical decision support systems and telemedicine on outcomes of depression: a cluster randomized trial in general practice

2020 ◽  
Vol 37 (6) ◽  
pp. 731-737
Author(s):  
Matteo Balestrieri ◽  
Davide Sisti ◽  
Marco Rocchi ◽  
Paola Rucci ◽  
Gregory Simon ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Decision Support ◽  
Randomized Trial ◽  
Clinical Decision Support ◽  
Clinical Decision Support Systems ◽  
Cluster Randomized Trial ◽  
Clinical Decision ◽  
Medical Interview ◽  
Cluster Randomized

Abstract Background Computerized Clinical Decision Support Systems (CCDSS) are information technology tools, designed to improve clinical decision-making. Telemedicine is a health care service delivery using videoconferencing, telephone or messaging technologies. Objectives Our project aimed at testing the effectiveness of a composite CCDSS and telemedicine approach designed to treat depression in primary care. Methods This cluster randomized trial involved four GP clinics located in Northern Italy. Two clinics were assigned to the experimental protocol, and two served as controls. The study compared the telemedicine group (TG), in which GPs had access to a CCDSS platform, with the control group (CG) in which GPs provided treatment as usual (TAU). Patients scoring ≥11 on Patient Heath Questionnaire and ≥26 on the Inventory of Depressive Symptomatology-Self-Report were eligible for participation. Patients were also administered the World Health Organization Quality of Life-BREF to assess quality of life and Medical Interview Satisfaction Scale 21 to assess satisfaction with the medical interview. Results Overall, 2810 patients were screened and 66 in the experimental group and 32 in the CG passed the screening stages and met inclusion criteria. The percentage of remitters at 6 months was significantly higher in the TG than in the CG group (24.1% versus 3.1%, χ 2 = 6.6, P = 0.01). This difference remained significant after adjusting for baseline confounders. Physical and psychological quality of life improved significantly from baseline in both groups. Patients reported, on average, good satisfaction with the medical interview. Conclusions Our study showed that a combined CCDSS and telemedicine approach may be more effective than the TAU offered by GPs to patients with depression. Trial registration The trial was registered on https://clinicaltrials.gov/ on 5 October 2012 with identifier: NCT01701791. The first participant was enrolled on 5 May 2014 and the study was completed on May 2016.

Utility of clinical technology-processes for developing countries

2014 ◽  
Vol 19 (3) ◽  
pp. 253-268 ◽  
Author(s):  
Nikunj Agarwal ◽  
M.P. Sebastian
Keyword(s):  
Developing Countries ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Medical Records ◽  
Positive Relationship ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
Content Type ◽  
The Usa

Purpose – The purpose of this paper is to evaluate the utility of clinical processes in healthcare institutions of different sizes. The implications of adoption rate of computerized physicians order entry (CPOE) and electronic medical/health records (EMRs/EHRs) in different sized healthcare institutions in the USA were studied in terms of understanding its impact on enhancement of quality of patient care. Design/methodology/approach – This study has used secondary data to obtain insights on the processes and technologies used in hospitals of different sizes in the USA and enlighten those in the developing countries to adopt a strategy that would be most appropriate for them. The Dorenfest Institute for H.I.T. Research and Education Analytics database (The Dorenfest Institute, 2011) provided the data for 5,038 US hospitals. Logistic regression was performed to study the impact of the different types of processes and technologies on institutions of different sizes, classified based on the number of beds, physicians, and nurses. Findings – The findings show that small sized hospitals had a positive relationship with drug dosing interactions process and nursing and clinician content process. On the contrary, medium sized hospitals had a negative relationship with the usage of CPOE for entering medical records, i.e. <25 percent (p<0.05). In order to be effective, these institutions should increase the usage of EMRs by more than 25 percent to get positive outcomes. Large hospitals showed a positive relationship with the usage of >75 percent of CPOE to enter medical records and usage of medical records >75 percent. Practical implications – The authors demonstrate the need for an evaluation of utility of acute care hospitals based on hospital size in terms of number of physicians, and nurses, which have not been dealt earlier by the past studies. Moreover, there is also a need for an evaluation of utility of acute care hospitals for implementation of CPOEs and EMRs that are integrated with clinical decision support systems. Originality/value – Although the data are US-centric, the insights provided by the results are very much relevant to the Indian scenario to support the improvement of the quality of care. The findings may help those implementing processes in healthcare institutions in India. No study has addressed the measurement of the positive and negative outcomes arising due to the implementation of different percentages of CPOEs and EMRs in different sized institutions. Further the number of physicians and nurses have not been considered earlier. Therefore, the authors have classified the hospitals based on physicians and nurses and studied their impact on the adoption of CPOEs, clinical decision support systems, and EMRs.

scholarly journals The use of computerized clinical decision support systems in emergency care: a substantive review of the literature

2016 ◽  
Vol 24 (3) ◽  
pp. 655-668 ◽  
Author(s):  
Paula Bennett ◽  
Nicholas R Hardiker
Keyword(s):  
Decision Support ◽  
Decision Support Systems ◽  
Clinical Decision Support ◽  
Emergency Care ◽  
Support Systems ◽  
Positive Impact ◽  
Clinical Decision Support Systems ◽  
Clinical Decision

Objectives: This paper provides a substantive review of international literature evaluating the impact of computerized clinical decision support systems (CCDSSs) on the care of emergency department (ED) patients. Material and Methods: A literature search was conducted using Medline, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Embase electronic resources, and gray literature. Studies were selected if they compared the use of a CCDSS with usual care in a face-to-face clinical interaction in an ED. Results: Of the 23 studies included, approximately half demonstrated a statistically significant positive impact on aspects of clinical care with the use of CCDSSs. The remaining studies showed small improvements, mainly around documentation. However, the methodological quality of the studies was poor, with few or no controls to mitigate against confounding variables. The risk of bias was high in all but 6 studies. Discussion: The ED environment is complex and does not lend itself to robust quantitative designs such as randomized controlled trials. The quality of the research in ∼75% of the studies was poor, and therefore conclusions cannot be drawn from these results. However, the studies with a more robust design show evidence of the positive impact of CCDSSs on ED patient care. Conclusion: This is the first review to consider the role of CCDSSs in emergency care and expose the research in this area. The role of CCDSSs in emergency care may provide some solutions to the current challenges in EDs, but further high-quality research is needed to better understand what technological solutions can offer clinicians and patients.

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