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

Author(s):  
Mehrdad Karajizadeh ◽  
Farid Zand ◽  
Roxana Sharifian ◽  
Afsaneh Vazin ◽  
Najmeh Bayati

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.

Author(s):  
Neurilene Batista de Oliveira ◽  
Heloísa Helena Ciqueto Peres

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.


JAMA Surgery ◽  
2017 ◽  
Vol 152 (7) ◽  
pp. 638 ◽  
Author(s):  
Zachary M. Borab ◽  
Michael A. Lanni ◽  
Michael G. Tecce ◽  
Christopher J. Pannucci ◽  
John P. Fischer

1993 ◽  
Vol 32 (01) ◽  
pp. 12-13 ◽  
Author(s):  
M. A. Musen

Abstract:Response to Heathfield HA, Wyatt J. Philosophies for the design and development of clinical decision-support systems. Meth Inform Med 1993; 32: 1-8.


2006 ◽  
Vol 45 (05) ◽  
pp. 523-527 ◽  
Author(s):  
A. Abu-Hanna ◽  
B. Nannings

Summary Objectives: Decision Support Telemedicine Systems (DSTS) are at the intersection of two disciplines: telemedicine and clinical decision support systems (CDSS). The objective of this paper is to provide a set of characterizing properties for DSTSs. This characterizing property set (CPS) can be used for typing, classifying and clustering DSTSs. Methods: We performed a systematic keyword-based literature search to identify candidate-characterizing properties. We selected a subset of candidates and refined them by assessing their potential in order to obtain the CPS. Results: The CPS consists of 14 properties, which can be used for the uniform description and typing of applications of DSTSs. The properties are grouped in three categories that we refer to as the problem dimension, process dimension, and system dimension. We provide CPS instantiations for three prototypical applications. Conclusions: The CPS includes important properties for typing DSTSs, focusing on aspects of communication for the telemedicine part and on aspects of decisionmaking for the CDSS part. The CPS provides users with tools for uniformly describing DSTSs.


2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
S M Jansen-Kosterink ◽  
M Cabrita ◽  
I Flierman

Abstract Background Clinical Decision Support Systems (CDSSs) are computerized systems using case-based reasoning to assist clinicians in making clinical decisions. Despite the proven added value to public health, the implementation of CDSS clinical practice is scarce. Particularly, little is known about the acceptance of CDSS among clinicians. Within the Back-UP project (Project Number: H2020-SC1-2017-CNECT-2-777090) a CDSS is developed with prognostic models to improve the management of Neck and/or Low Back Pain (NLBP). Therefore, the aim of this study is to present the factors involved in the acceptance of CDSSs among clinicians. Methods To assess the acceptance of CDSSs among clinicians we conducted a mixed method analysis of questionnaires and focus groups. An online questionnaire with a low-fidelity prototype of a CDSS (TRL3) was sent to Dutch clinicians aimed to identify the factors influencing the acceptance of CDSSs (intention to use, perceived threat to professional autonomy, trusting believes and perceived usefulness). Next to this, two focus groups were conducted with clinicians addressing the general attitudes towards CDSSs, the factors determining the level of acceptance, and the conditions to facilitate use of CDSSs. Results A pilot-study of the online questionnaire is completed and the results of the large evaluation are expected spring 2020. Eight clinicians participated in two focus groups. After being introduced to various types of CDSSs, participants were positive about the value of CDSS in the care of NLBP. The clinicians agreed that the human touch in NLBP care must be preserved and that CDSSs must remain a supporting tool, and not a replacement of their role as professionals. Conclusions By identifying the factors hindering the acceptance of CDSSs we can draw implications for implementation of CDSSs in the treatment of NLBP.


Author(s):  
Tessa Jaspers ◽  
Marjolijn Duisenberg-van Essenberg ◽  
Barbara Maat ◽  
Marc Durian ◽  
Roy van den Berg ◽  
...  

AbstractBackground Venous thromboembolism is a potentially fatal complication of hospitalisation, affecting approximately 3% of non-surgical patients. Administration of low molecular weight heparins to the appropriate patients adequately decreases venous thromboembolism incidence, but guideline adherence is notoriously low. Objective To determine the effect of a multifaceted intervention on thromboprophylaxis guideline adherence. The secondary objective was to study the effect on guideline adherence specifically in patients with a high venous thromboembolism risk. As an exploratory objective, we determined how many venous thromboembolisms may be prevented. Setting A Dutch general teaching hospital. Method A prospective study with a pre- and post-intervention measurement was conducted. A multifaceted intervention, consisting of Clinical Decision Support software, a mobile phone application, monitoring of duplicate anticoagulants and training, was implemented. Guideline adherence was assessed by calculating the Padua prediction and Improve bleeding score for each patient. The number of preventable venous thromboembolisms was calculated using the incidences of venous thromboembolism in patients with and without adequate thromboprophylaxis and extrapolated to the annual number of admitted patients. Main outcome measure Adherence to thromboprophylaxis guidelines in pre- and post-intervention measurements. Results 170 patients were included: 85 in both control and intervention group. The intervention significantly increased guideline adherence from 49.4 to 82.4% (OR 4.78; 95%CI 2.37–9.63). Guideline adherence in the patient group with a high venous thromboembolism risk also increased significantly from 54.5 to 84.3% (OR 2.46; 95%CI 1.31–4.62), resulting in the potential prevention of ± 261 venous thromboembolisms per year. Conclusions Our multifaceted intervention significantly increased thromboprophylaxis guideline adherence.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Elizabeth Ford ◽  
Natalie Edelman ◽  
Laura Somers ◽  
Duncan Shrewsbury ◽  
Marcela Lopez Levy ◽  
...  

Abstract Background Well-established electronic data capture in UK general practice means that algorithms, developed on patient data, can be used for automated clinical decision support systems (CDSSs). These can predict patient risk, help with prescribing safety, improve diagnosis and prompt clinicians to record extra data. However, there is persistent evidence of low uptake of CDSSs in the clinic. We interviewed UK General Practitioners (GPs) to understand what features of CDSSs, and the contexts of their use, facilitate or present barriers to their use. Methods We interviewed 11 practicing GPs in London and South England using a semi-structured interview schedule and discussed a hypothetical CDSS that could detect early signs of dementia. We applied thematic analysis to the anonymised interview transcripts. Results We identified three overarching themes: trust in individual CDSSs; usability of individual CDSSs; and usability of CDSSs in the broader practice context, to which nine subthemes contributed. Trust was affected by CDSS provenance, perceived threat to autonomy and clear management guidance. Usability was influenced by sensitivity to the patient context, CDSS flexibility, ease of control, and non-intrusiveness. CDSSs were more likely to be used by GPs if they did not contribute to alert proliferation and subsequent fatigue, or if GPs were provided with training in their use. Conclusions Building on these findings we make a number of recommendations for CDSS developers to consider when bringing a new CDSS into GP patient records systems. These include co-producing CDSS with GPs to improve fit within clinic workflow and wider practice systems, ensuring a high level of accuracy and a clear clinical pathway, and providing CDSS training for practice staff. These recommendations may reduce the proliferation of unhelpful alerts that can result in important decision-support being ignored.


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