scholarly journals Electronic Clinical Decision Support for Children with Minor Head Trauma and Intracranial Injuries: A Sociotechnical Analysis

2020 ◽  
Author(s):  
Jacob K Greenberg ◽  
Ayodamola Otun ◽  
Azzah Nasraddin ◽  
Ross C Brownson ◽  
Nathan Kuppermann ◽  
...  
Keyword(s):  
Information Technology ◽  
Decision Support ◽  
Focus Group ◽  
Clinical Decision Support ◽  
Thematic Analysis ◽  
Clinical Decision ◽  
Evidence Based ◽  
Minor Head Trauma ◽  
Technology Specialists ◽  
Electronic Clinical Decision Support

Abstract Background: Current management of children with minor head trauma (MHT) and intracranial injuries is not evidence-based and may place some children at risk of harm. Evidence-based electronic clinical decision support (CDS) for management of these children may improve patient safety and decrease resource use. To guide these efforts, we evaluated the sociotechnical environment impacting the implementation of electronic CDS, including workflow and communication, institutional culture, and hardware and software infrastructure, among other factors. Methods: Between March and May, 2020 semi-structured qualitative focus group interviews were conducted to identify sociotechnical influences on CDS implementation. Physicians from neurosurgery, emergency medicine, critical care, and pediatric general surgery were included, along with information technology specialists. Participants were recruited from nine health centers in the United States. Focus group transcripts were coded and analyzed using thematic analysis. The final themes were then cross-referenced with previously defined sociotechnical dimensions.Results: We included 28 physicians and four information technology specialists in seven focus groups (median five participants per group). Five physicians were trainees and 10 had administrative leadership positions. Through inductive thematic analysis, we identified five primary themes: 1) clinical impact; 2) stakeholders and users; 3) tool content; 4) clinical practice integration; and 5) post-implementation evaluation measures. Participants generally supported using CDS to determine an appropriate level-of-care for these children. However, some had mixed feelings regarding how the tool could best be used by different specialties (e.g. use by neurosurgeons versus non-neurosurgeons). Feedback from the interviews helped refine the tool content and also highlighted potential technical and workflow barriers to address prior to implementation. Conclusions: We identified key factors impacting the implementation of electronic CDS for children with MHT and intracranial injuries. These results have informed our implementation strategy and may also serve as a template for future efforts to implement health information technology in a multidisciplinary, emergency setting.

scholarly journals Electronic clinical decision support for children with minor head trauma and intracranial injuries: a sociotechnical analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jacob K. Greenberg ◽  
Ayodamola Otun ◽  
Azzah Nasraddin ◽  
Ross C. Brownson ◽  
Nathan Kuppermann ◽  
...  
Keyword(s):  
Information Technology ◽  
Decision Support ◽  
Focus Group ◽  
Clinical Decision Support ◽  
Thematic Analysis ◽  
Clinical Decision ◽  
Evidence Based ◽  
Minor Head Trauma ◽  
Technology Specialists ◽  
Electronic Clinical Decision Support

Abstract Background Current management of children with minor head trauma (MHT) and intracranial injuries is not evidence-based and may place some children at risk of harm. Evidence-based electronic clinical decision support (CDS) for management of these children may improve patient safety and decrease resource use. To guide these efforts, we evaluated the sociotechnical environment impacting the implementation of electronic CDS, including workflow and communication, institutional culture, and hardware and software infrastructure, among other factors. Methods Between March and May, 2020 semi-structured qualitative focus group interviews were conducted to identify sociotechnical influences on CDS implementation. Physicians from neurosurgery, emergency medicine, critical care, and pediatric general surgery were included, along with information technology specialists. Participants were recruited from nine health centers in the United States. Focus group transcripts were coded and analyzed using thematic analysis. The final themes were then cross-referenced with previously defined sociotechnical dimensions. Results We included 28 physicians and four information technology specialists in seven focus groups (median five participants per group). Five physicians were trainees and 10 had administrative leadership positions. Through inductive thematic analysis, we identified five primary themes: (1) clinical impact; (2) stakeholders and users; (3) tool content; (4) clinical practice integration; and (5) post-implementation evaluation measures. Participants generally supported using CDS to determine an appropriate level-of-care for these children. However, some had mixed feelings regarding how the tool could best be used by different specialties (e.g. use by neurosurgeons versus non-neurosurgeons). Feedback from the interviews helped refine the tool content and also highlighted potential technical and workflow barriers to address prior to implementation. Conclusions We identified key factors impacting the implementation of electronic CDS for children with MHT and intracranial injuries. These results have informed our implementation strategy and may also serve as a template for future efforts to implement health information technology in a multidisciplinary, emergency setting.

scholarly journals LO73: A randomized controlled trial of electronic clinical decision support to reduce unnecessary CT imaging for patients with suspected pulmonary embolism

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S32-S33
Author(s):  
J.E. Andruchow ◽  
D. Grigat ◽  
A.D. McRae ◽  
T. Abedin ◽  
D. Wang ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Randomized Controlled Trial ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Controlled Trial ◽  
Clinical Decision ◽  
Evidence Based ◽  
Index Visit ◽  
Randomized Controlled ◽  
Electronic Clinical Decision Support

Introduction: Utilization of CT pulmonary angiography (CTPA) to rule out pulmonary embolism (PE) has risen dramatically but diagnostic yield has fallen over the past several decades, suggesting that lower risk patients are being tested. Given little evidence to suggest improved patient outcomes with higher CTPA utilization, and increasing evidence of harm, evidence-based guidelines have been developed to reduce unnecessary CTPA use. The objective of this study was to assess the impact of an electronic clinical decision support (CDS) intervention to reduce unnecessary CTPA utilization for emergency department (ED) patients with suspected PE. Methods: This was a cluster-randomized, controlled trial with physicians as the unit of randomization. All emergency physicians (EPs) at 4 urban adult EDs and 1 urgent care center were randomly assigned to receive either evidence-based imaging CDS for patients with suspected PE (intervention) or no CDS (control) over a 1-year study period. CDS was launched in an external web browser whenever an intervention EP ordered a CTPA from the computerized physician order entry software for ED patients CTAS 2-5; however, physician interaction with CDS was voluntary. The CDS tool enabled calculation of patient-specific information, including the patients Wells score, PERC score, and age-adjusted D-dimer, as well as prediction of each patients pre-test risk of PE along with an imaging/no imaging recommendation. CDS recommendations could be printed for the medical record as could educational patient handouts to support physician decision-making. The primary outcome was CTPA utilization for patients with CEDIS chief complaints of shortness of breath or chest pain on the index visit. Secondary outcomes included index visit length of stay (LOS), and CTPA use or VTE diagnosis within 90-days. This study was REB approved. Results: Demographics were similar among intervention and control EPs; however, during a 2-year pre-intervention period control EPs had a higher baseline CTPA rate (8.5% vs 7.7%, p<0.001). In the first 8-months following CDS implementation, 94 intervention EPs saw 9,609 patients and voluntarily interacted with the CDS tool on 43.2% of eligible encounters while 91 control EPs saw 9,498 patients. CTPA utilization was higher among intervention EPs than control (9.6% vs 8.3%, p<0.001) as was ED LOS (302 vs 287 minutes, p<0.001). There was no difference in 90-day CTPA use or VTE diagnoses. Conclusion: In one of the largest RCTs of CDS to date, exposure to CDS was associated with higher rates of CTPA utilization and longer ED LOS on the index visit, and no difference in 90-day CT use or VTE diagnoses. These results differ from a concurrent study of CDS for patients with mild traumatic brain injury in the same physician population and may relate to the implementation of the CDS intervention and/or complexity of the underlying evidence-based algorithms.

scholarly journals Utilization and effects of mobile electronic clinical decision support on pediatric asthma care quality in the emergency department and inpatient setting

JAMIA Open ◽  
2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Ellen Kerns ◽  
Russell McCulloh ◽  
Sarah Fouquet ◽  
Corrie McDaniel ◽  
Lynda Ken ◽  
...  
Keyword(s):  
Emergency Department ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Pediatric Asthma ◽  
Clinical Decision ◽  
Care Quality ◽  
Asthma Care ◽  
Mixed Effect ◽  
National Quality ◽  
Electronic Clinical Decision Support

Abstract Objective To determine utilization and impacts of a mobile electronic clinical decision support (mECDS) on pediatric asthma care quality in emergency department and inpatient settings. Methods We conducted an observational study of a mECDS tool that was deployed as part of a multi-dimensional, national quality improvement (QI) project focused on pediatric asthma. We quantified mECDS utilization using cumulative screen views over the study period in the city in which each participating site was located. We determined associations between mECDS utilization and pediatric asthma quality metrics using mixed-effect logistic regression models (adjusted for time, site characteristics, site-level QI project engagement, and patient characteristics). Results The tool was offered to clinicians at 75 sites and used on 286 devices; cumulative screen views were 4191. Children’s hospitals and sites with greater QI project engagement had higher cumulative mECDS utilization. Cumulative mECDS utilization was associated with significantly reduced odds of hospital admission (OR: 0.95, 95% CI: 0.92–0.98) and higher odds of caregiver referral to smoking cessation resources (OR: 1.08, 95% CI: 1.01–1.16). Discussion We linked mECDS utilization to clinical outcomes using a national sample and controlling for important confounders (secular trends, patient case mix, and concomitant QI efforts). We found mECDS utilization was associated with improvements in multiple measures of pediatric asthma care quality. Conclusion mECDS has the potential to overcome barriers to dissemination and improve care on a broad scale. Important areas of future work include improving mECDS uptake/utilization, linking clinicians’ mECDS usage to clinical practice, and studying mECDS’s impacts on other common pediatric conditions.

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.

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