Laboratory test ordering in inpatient hospitals: a systematic review on the effects and features of clinical decision support systems

Abstract Background Studies have revealed inappropriate laboratory testing as a source of waste. This review aimed at evaluating the effects and features of CDSSs on physicians' appropriate laboratory test ordering in inpatient hospitals. Method Medline through PubMed, SCOPUS, Web of Science, and Cochrane were queried without any time period restriction. Studies using CDSSs as an intervention to improve laboratory test ordering as the primary aim were included. The study populations in the included studies were laboratory tests, physicians ordering laboratory tests, or the patients for whom laboratory tests were ordered. The included papers were evaluated for their outcomes related to the effect of CDSSs which were categorized based on the outcomes related to tests, physician, and patients. The primary outcome measures were the number and cost of the ordered laboratory tests. The instrument from The National Heart Lung and Blood Institute (NIH) was used to assess the quality of the included studies. Moreover, we applied a checklist for assessing the quality and features of the CDSSs presented in the included studies. A narrative synthesis was used to describe and compare the designs and the results of included studies. Result Sixteen studies met the inclusion criteria. Most studies were conducted based on a quasi-experimental design. The results showed improvement in laboratory test-related outcomes (e.g. proportion and cost of tests) and also physician-related outcomes (e.g. guideline adherence and orders cancellation). Patient-related outcomes (e.g. length of stay and mortality rate) were not well investigated in the included studies. In addition, the evidence about applying CDSS as a decision aid for interpreting laboratory results was rare. Conclusion CDSSs increase appropriate test ordering in hospitals through eliminating redundant test orders and enhancing evidence-based practice. Appropriate testing and cost saving were both affected by the CDSSs. However, the evidence is limited about the effects of laboratory test CDSSs on patient-related outcomes.

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Laboratory test ordering in inpatient hospitals: a systematic review on the effects and features of clinical decision support systems

10.21203/rs.3.rs-46748/v3 ◽

2020 ◽

Author(s):

Sahar Zare ◽

Zahra Meidani ◽

Mohammad Shirdeli ◽

Ehsan Nabovati

Keyword(s):

Laboratory Test ◽

Laboratory Tests ◽

Clinical Decision Support Systems ◽

Clinical Decision ◽

Blood Institute ◽

Time Period ◽

National Heart Lung ◽

Quasi Experimental ◽

Test Ordering

Abstract Background: Studies have revealed inappropriate laboratory testing as a source of waste. This review aimed at evaluating the effects and features of CDSSs on physicians' appropriate laboratory test ordering in inpatient hospitals.Method: Medline through PubMed, SCOPUS, Web of Science, and Cochrane were queried without any time period restriction. Studies using CDSSs as an intervention to improve laboratory test ordering as the primary aim were included. The study populations in the included studies were laboratory tests, physicians ordering laboratory tests, or the patients for whom laboratory tests were ordered. The included papers were evaluated for their outcomes related to the effect of CDSSs which were categorized based on the outcomes related to tests, physician, and patients. The primary outcome measures were the number and cost of the ordered laboratory tests. The instrument from The National Heart Lung and Blood Institute (NIH) was used to assess the quality of the included studies. Moreover, we applied a checklist for assessing the quality and features of the CDSSs presented in the included studies. A narrative synthesis was used to describe and compare the designs and the results of included studies.Result: Sixteen studies met the inclusion criteria. Most studies were conducted based on a quasi-experimental design. The results showed improvement in laboratory test-related outcomes (e.g. proportion and cost of tests) and also physician-related outcomes (e.g. guideline adherence and orders cancellation). Patient-related outcomes (e.g. length of stay and mortality rate) were not well investigated in the included studies. In addition, the evidence about applying CDSS as a decision aid for interpreting laboratory results was rare.Conclusion: CDSSs increase appropriate test ordering in hospitals through eliminating redundant test orders and enhancing evidence-based practice. Appropriate testing and cost saving were both affected by the CDSSs. However, the evidence is limited about the effects of laboratory test CDSSs on patient-related outcomes.

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Laboratory Test Ordering in Inpatient Hospitals: A Scoping Review on the Effects and Features of Clinical Decision Support Systems

10.21203/rs.3.rs-46748/v1 ◽

2020 ◽

Author(s):

Sahar Zare ◽

Zahra Meidani ◽

Mohammad Shirdeli ◽

Ehsan Nabovati

Keyword(s):

Laboratory Test ◽

Decision Aid ◽

Primary Outcome ◽

Web Of Science ◽

Clinical Decision Support Systems ◽

Clinical Decision ◽

Inclusion Criteria ◽

Time Period ◽

Quasi Experimental ◽

Test Ordering

Abstract Background: Studies have revealed inappropriate laboratory testing as a source of waste. This review was aimed to evaluate the effects and features of CDSSs on physicians' appropriate laboratory test ordering in inpatient hospitals.Method: Medline through PubMed, SCOPUS, Web of Science, and Cochrane were queried without any time period restriction. The outcomes were categorized based on test-related, physician-related, and patient-related. The primary outcome measures were the number and cost of laboratory test ordered.Result: Sixteen studies met the inclusion criteria. Most studies were conducted based on a quasi-experimental design. The results showed improvement in laboratory test-related outcomes (e.g. proportion and cost of tests) and also physician-related outcomes (e.g. guideline adherence and orders cancellation). Patient-related outcomes (e.g. length of stay and mortality rate) were not well investigated in the included studies. Also, the evidence about applying CDSS as a decision aid for interpreting laboratory results was rare.Conclusion: CDSSs increase appropriate test ordering in hospitals through eliminating redundant test orders and enhancing evidence-based practice. Appropriate testing and cost saving were both affected by the CDSSs. However the evidence is limited about the effects of laboratory test CDSSs on patient-related outcomes.

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Laboratory test ordering in inpatient hospitals: a systematic review on the effects and features of clinical decision support systems

10.21203/rs.3.rs-46748/v2 ◽

2020 ◽

Author(s):

Sahar Zare ◽

Zahra Meidani ◽

Mohammad Shirdeli ◽

Ehsan Nabovati

Keyword(s):

Laboratory Test ◽

Decision Aid ◽

Web Of Science ◽

Clinical Decision Support Systems ◽

Clinical Decision ◽

Inclusion Criteria ◽

Time Period ◽

Laboratory Results ◽

Quasi Experimental ◽

Test Ordering

Abstract Background: Studies have revealed inappropriate laboratory testing as a source of waste. This review aimed at evaluating the effects and features of CDSSs on physicians' appropriate laboratory test ordering in inpatient hospitals.Method: Medline through PubMed, SCOPUS, Web of Science, and Cochrane were queried without any time period restriction. The outcomes related to the effect of CDSSs were categorized based on test-related, physician-related, and patient-related. Result: Sixteen studies met the inclusion criteria. Most studies were conducted based on a quasi-experimental design. The results showed improvement in laboratory test-related outcomes (e.g. proportion and cost of tests) and also physician-related outcomes (e.g. guideline adherence and orders cancellation). Patient-related outcomes (e.g. length of stay and mortality rate) were not well investigated in the included studies. Also, the evidence about applying CDSS as a decision aid for interpreting laboratory results was rare.Conclusion: CDSSs increase appropriate test ordering in hospitals through eliminating redundant test orders and enhancing evidence-based practice. Appropriate testing and cost saving were both affected by the CDSSs. However the evidence is limited about the effects of laboratory test CDSSs on patient-related outcomes.

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

Revista Latino-Americana de Enfermagem ◽

10.1590/1518-8345.4510.3426 ◽

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.

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The Effects of Computerized Clinical Decision Support Systems on Laboratory Test Ordering: A Systematic Review

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2016-0115-ra ◽

2017 ◽

Vol 141 (4) ◽

pp. 585-595 ◽

Cited By ~ 14

Author(s):

Nicolas Delvaux ◽

Katrien Van Thienen ◽

Annemie Heselmans ◽

Stijn Van de Velde ◽

Dirk Ramaekers ◽

...

Keyword(s):

Decision Support ◽

Laboratory Test ◽

Decision Support Systems ◽

Clinical Decision Support ◽

Support System ◽

Clinical Decision Support System ◽

Support Systems ◽

Clinical Decision Support Systems ◽

Clinical Decision ◽

Test Ordering

Context.— Inappropriate laboratory test ordering has been shown to be as high as 30%. This can have an important impact on quality of care and costs because of downstream consequences such as additional diagnostics, repeat testing, imaging, prescriptions, surgeries, or hospital stays. Objective.— To evaluate the effect of computerized clinical decision support systems on appropriateness of laboratory test ordering. Data Sources.— We used MEDLINE, Embase, CINAHL, MEDLINE In-Process and Other Non-Indexed Citations, Clinicaltrials.gov, Cochrane Library, and Inspec through December 2015. Investigators independently screened articles to identify randomized trials that assessed a computerized clinical decision support system aimed at improving laboratory test ordering by providing patient-specific information, delivered in the form of an on-screen management option, reminder, or suggestion through a computerized physician order entry using a rule-based or algorithm-based system relying on an evidence-based knowledge resource. Investigators extracted data from 30 papers about study design, various study characteristics, study setting, various intervention characteristics, involvement of the software developers in the evaluation of the computerized clinical decision support system, outcome types, and various outcome characteristics. Conclusions.— Because of heterogeneity of systems and settings, pooled estimates of effect could not be made. Data showed that computerized clinical decision support systems had little or no effect on clinical outcomes but some effect on compliance. Computerized clinical decision support systems targeted at laboratory test ordering for multiple conditions appear to be more effective than those targeted at a single condition.

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Evaluation and cost estimation of laboratory tests overuse through a CCDSS in a university hospital

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.221 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

D Vallone ◽

A Tamburrano ◽

C Carrozza ◽

A Urbani ◽

A Cambieri ◽

...

Keyword(s):

Cost Estimation ◽

Laboratory Tests ◽

Quality Care ◽

Clinical Decision Support Systems ◽

Patient Characteristics ◽

Clinical Decision ◽

University Hospital ◽

Specific Patient ◽

Global Rate ◽

Common Laboratory

Abstract Computerized Clinical Decision Support Systems (CCDSS) are information technology-based systems that use specific patient characteristics and combine them with rule-based algorithms. The aim of this study is to conduct a survey to measure and assess the over-utilization rates of laboratory requests and to estimate the monthly cost of inappropriate requests in inpatients of the “Fondazione Policlinico Universitario A. Gemelli IRCCS” Care Units. This observational study is based on the count of rules violations for 43 different types of laboratory tests requested by the Hospital physicians, for a total of 5,716,370 requests, over a continuous period of 20 months (from 1 July 2016 to 28 February 2018). Requests from all the hospital internal departments (except for Emergency, Intensive Care Units and Urgent requests) were monitored. The software intercepted and counted, in silent mode for the operator, all requests and violations for each laboratory test among those identified. During the observation period a mean of 285,819 requests per month were analyzed and 40,462 violations were counted. The global rate of overuse was 15.2% ± 3.0%. The overall difference among sub-groups was significant (p < 0.001). The most inappropriate exams were Alpha Fetoprotein (85.8% ± 30.5%), Chlamydia trachomatis PCR (48.7% ± 8.8%) and Alkaline Phosphatase (20.3% ± 6.5%). All the exams, globally considered, generated an estimated avoidable cost of 1,719,337€ (85,967€ per month) for the hospital. This study reports rates (15.2%) similar to other works. The real impact of inappropriateness is difficult to assess, but the generated costs for patients, hospitals and health systems are certainly high and not negligible. Key messages It would be desirable for international medical communities to produce a complete panel of prescriptive rules for all the most common laboratory exam. That is useful not only to reduce costs, but also to ensure standardization and high-quality care.

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Economic and organizational impact of a clinical decision support system on laboratory test ordering

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-017-0574-6 ◽

2017 ◽

Vol 17 (1) ◽

Cited By ~ 5

Author(s):

Elena Bellodi ◽

Emidia Vagnoni ◽

Barbara Bonvento ◽

Evelina Lamma

Keyword(s):

Decision Support ◽

Decision Support System ◽

Laboratory Test ◽

Clinical Decision Support ◽

Support System ◽

Clinical Decision Support System ◽

Clinical Decision ◽

Organizational Impact ◽

Test Ordering

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Clinical decision support improves the appropriateness of laboratory test ordering in primary care without increasing diagnostic error: the ELMO cluster randomized trial

10.21203/rs.3.rs-64077/v2 ◽

2020 ◽

Author(s):

Nicolas Delvaux ◽

Veerle Piessens ◽

Tine De Burghgraeve ◽

Pavlos Mamouris ◽

Bert Vaes ◽

...

Keyword(s):

Primary Care ◽

Decision Support ◽

Laboratory Test ◽

Clinical Decision Support ◽

Clinical Decision ◽

Diagnostic Error ◽

Order Sets ◽

Cluster Randomized ◽

Physician Order Entry ◽

Test Ordering

Abstract Background Inappropriate laboratory test ordering poses an important burden for healthcare. Clinical decision support systems (CDSS) have been cited as promising tools to improve laboratory test ordering behavior. The objectives of this study were to evaluate the effects of an intervention that integrated a clinical decision support service into a computerized physician order entry (CPOE) on the appropriateness and volume of laboratory test ordering, and on diagnostic error in primary care.Methods This study was a pragmatic, cluster randomized, open label, controlled clinical trial. Setting 280 general practitioners (GPs) from 72 primary care practices in Belgium. Patients Patients aged ≥18 years with a laboratory test order for at least one of 17 indications; cardiovascular disease management, hypertension, check-up, chronic kidney disease (CKD), thyroid disease, type 2 diabetes mellitus, fatigue, anemia, liver disease, gout, suspicion of acute coronary syndrome (ACS), suspicion of lung embolism, rheumatoid arthritis, sexually transmitted infections (STI), acute diarrhea, chronic diarrhea, and follow-up of medication. Interventions The CDSS was integrated into a computerized physician order entry (CPOE) in the form of evidence-based order sets that suggested appropriate tests based on the indication provided by the general physician. Measurements The primary outcome of the ELMO study was the proportion of appropriate tests over the total number of ordered tests and inappropriately not-requested tests. Secondary outcomes of the ELMO study included diagnostic error, test volume and cascade activities.Results CDSS increased the proportion of appropriate tests by 0.21 (95% CI 0.16 - 0.26, p<.0001) for all tests included in the study. GPs in the CDSS arm ordered 7 (7.15 (95% CI 3.37 - 10.93, p=.0002)) tests fewer per panel. CDSS did not increase diagnostic error. The absolute difference in proportions was a decrease of 0.66% (95% CI 1.4% decrease - 0.05% increase) in possible diagnostic error.Conclusions A CDSS in the form of order sets, integrated within the CPOE improved appropriateness and decreased volume of laboratory test ordering without increasing diagnostic error. Trial Registration Clinicaltrials.gov Identifier: NCT02950142, registered on October 25, 2016Funding source This study was funded through the Belgian Health Care Knowledge Centre (KCE) Trials Programme agreement KCE16011.

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GEOTECHNICAL CHARACTERISTICS OF EMBANKMENT ALONG THE RAILWAY ROUTE OF ENTITY BORDER OF FEDERATION OF BIH – MAGLAJ, SECTION km 103+500 MAGLAJ

Archives for Technical Sciences ◽

10.7251/afts.2017.0916.019d ◽

2017 ◽

Vol 1 (16) ◽

Author(s):

Neđo Đurić

Keyword(s):

European Union ◽

Laboratory Tests ◽

Soil Depth ◽

The Other ◽

Geotechnical Characteristics ◽

Time Period ◽

European Union Countries ◽

Improvement Measures ◽

Train Speed

Railway route from entity border to Maglaj is on corridor V of railways that connects Adriatic seawith European Union countries. More precisely, it is on the railway Samac – Sarajevo that was builtduring the fifties. From Doboj to Zenica exist two tracks, one built in 1947. and the other thirty yearslater. In time, the railway worn out, since it was not maintained properly during its exploitation, soallowed train speed is 40 km/h. Reconstruction of railway had previously started on sections with aimto achieve the level of train speed to 120 km/h.Terrain research in order to overview quality of material on which the railway is laid, and immediateenvironment that has effect on railway route, were conducted by sections, from which section km103+500 – Maglaj is one of the most important considering characteristics of the terrain on which theroute passes. Research along railway route were conducted by using research trial pits from both sidesand in between tracks, to depth of entry in basic soil. Depth of research works is different for old andnew track, considering the way of construction in time period of 30 years. Beyond narrow corridor ofrailway route research of characteristics of the terrain were not conducted, because of inability toaccess due to mining. Results of terrain and laboratory tests showed geotechnical characteristics ofmaterial, based on which were given quality improvement measures for deposited materials, and basefor reconstruction of railway.

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