Stakeholder Perspectives on an Inpatient Hypoglycemia Informatics Alert: A Mixed Methods Study (Preprint)

2021 ◽  
Author(s):  
Nestoras Mathioudakis ◽  
Moeen Aboabdo ◽  
Mohammed Abusamaan ◽  
Christina Yuan ◽  
LaPricia Lewis Boyer ◽  
...  
Keyword(s):  
Decision Support ◽  
Mixed Methods ◽  
Focus Group ◽  
Real Time ◽  
Clinical Decision Support ◽  
Hospital Setting ◽  
Clinical Decision ◽  
Mixed Methods Study ◽  
Electronic Survey ◽  
Group Sessions

BACKGROUND Iatrogenic hypoglycemia is a common occurrence among hospitalized patients and is associated with poor clinical outcomes and increased mortality. Clinical decision support systems could be utilized to reduce the incidence of this potentially avoidable adverse event. OBJECTIVE To determine the desired features and functionality of a real-time informatics alert to prevent iatrogenic hypoglycemia in the hospital setting. METHODS Using the Agency for Healthcare Research and Quality (AHRQ) Five Rights of Effective Clinical Decision Support Framework, we conducted a mixed methods study using an electronic survey and focus group sessions of hospital-based providers. The goal was to elicit stakeholder input to inform future development of a real-time informatics alert to target iatrogenic hypoglycemia. In addition to perceptions about the importance of the problem and existing barriers, we sought input regarding the content, format, channel, timing, and recipient for the alert (i.e. the “Five Rights”). Thematic analysis of focus group sessions was conducted using deductive and inductive approaches. RESULTS A 21-item electronic survey was completed by 102 inpatient-based providers, followed by two focus group sessions (6 providers per session). Respondents universally agreed/strongly agreed that inpatient iatrogenic hypoglycemia is an important problem that could be addressed with an informatics alert. Stakeholders expressed preference for an alert that is non-intrusive, accurate, communicated in near real-time to the ordering provider and provides actionable treatment recommendations. Several electronic medical record tools, including alert indicators in the patient header, glucose management report, and laboratory results section were deemed acceptable formats for consideration. Concerns regarding alert fatigue were prevalent among both survey respondents and focus group participants. CONCLUSIONS The design preferences we identified from this study will provide the framework needed for an informatics team to develop a prototype alert for pilot testing and evaluation. This alert will help meet the needs of hospital-based clinicians caring for patients with diabetes who are at high risk of treatment-related hypoglycemia.

scholarly journals Real-time use of the iPad by third-year medical students for clinical decision support and learning: a mixed methods study

2014 ◽  
Vol 4 (4) ◽  
pp. 25184 ◽  
Author(s):  
Michelle A. Nuss ◽  
Janette R. Hill ◽  
Ronald M. Cervero ◽  
Julie K. Gaines ◽  
Bruce F. Middendorf
Keyword(s):  
Decision Support ◽  
Mixed Methods ◽  
Medical Students ◽  
Real Time ◽  
Clinical Decision Support ◽  
Time Use ◽  
Clinical Decision ◽  
Mixed Methods Study

scholarly journals Applying the RE-AIM Framework for the Evaluation of a Clinical Decision Support Tool for Pediatric Head Trauma: A Mixed-Methods Study

2018 ◽  
Vol 09 (03) ◽  
pp. 693-703 ◽  
Author(s):  
Ruth Masterson Creber ◽  
Peter Dayan ◽  
Nathan Kuppermann ◽  
Dustin Ballard ◽  
Leah Tzimenatos ◽  
...  
Keyword(s):  
Decision Support ◽  
Mixed Methods ◽  
Head Trauma ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Mixed Methods Study ◽  
Research Network ◽  
Cranial Computed Tomography ◽  
Successful Implementation ◽  
Blunt Head Trauma

Background The overuse of cranial computed tomography (CT) to diagnose potential traumatic brain injuries (TBIs) exposes children with minor blunt head trauma to unnecessary ionizing radiation. The Pediatric Emergency Care Applied Research Network and the Clinical Research on Emergency Services and Treatments Network implemented TBI prediction rules via electronic health record (EHR) clinical decision support (CDS) to decrease use of CTs in children with minor blunt head trauma. Objective This article aims to facilitate implementation and dissemination of a CDS alert into emergency departments around the country. Methods We evaluated the EHR CT CDS tool through a mixed-methods analysis of 38 audio-recorded interviews with health care stakeholders and quantitative data sources, using the Reach, Efficacy, Adoption, Implementation, and Maintenance framework. Results Reach —The demographics of participants enrolled in the clinical trial were consistent with national estimates of TBI prevalence. Efficacy—There was a variable and modest reduction in CT rates for the 8,067 children with minor head trauma whose clinicians received CDS. Adoption —The EHR CT CDS tool was well matched with the organizational mission, values, and priorities of the implementation sites. Implementation— The most important predisposing factors for successful implementation were the presence of an approachable clinical champion at each site and belief that the tool was a relevant, reusable knowledge asset. Enabling factors included an effective integration within the clinical workflow, organizational investment in user training, and ease of use. Maintenance — Reinforcing factors for the EHR CT CDS tool included a close fit with the institutional culture, belief that it was useful for providers and families, and a good educational and informational tool. As such, the EHR CT CDS tool was maintained in clinical practice long after study completion. Conclusion Data from this mixed-methods study complement findings from the efficacy trial and provide critical components for consideration prior to integration and subsequent dissemination of the EHR CT CDS tool. Trial Registration NCT01453621, Registered September 27, 2011

scholarly journals Improving Blood Transfusion Practices in a Community Hospital Setting: Our Experience with Real-Time Clinical Decision Support

2018 ◽  
Vol 6 (3) ◽  
pp. 67
Author(s):  
Muhammad Sardar ◽  
Muhammad Azharuddin ◽  
Ananta Subedi ◽  
Prateek Ghatage ◽  
Doantarang Du ◽  
...  
Keyword(s):  
Decision Support ◽  
Real Time ◽  
Clinical Decision Support ◽  
Community Hospital ◽  
Statistical Significance ◽  
Hospital Setting ◽  
Clinical Decision ◽  
Good Evidence ◽  
Blood Utilization ◽  
The Impact

There is good evidence that 50% or more of red blood cell (RBC) transfusions are unnecessary. To curtail inappropriate RBC transfusions at our hospital, real-time clinical decision support was implemented in our electronic medical record (EMR) that alerts clinicians to the patient’s most recent pretransfusion hemoglobin value upon order entry and provides Best Practice Advisory. This is a soft pop-up alert which is activated when the hemoglobin exceeds 7 g/dL. The ordering clinician can either honor (by cancelling the order) or override the alert. We studied the impact of the alert on blood utilization during a 3-month period (November 2016 to January 2017). For patients who were transfused despite the alert, a retrospective review of the medical chart was performed to determine whether or not the transfusion was clinically indicated. During the study period, 178 of the 895 RBC transfusion orders (20%) triggered the alert. After excluding duplicates, 144 orders were included in our analysis. Most of these orders (124/144, 86%) were carried out despite the alert. According to our chart review, 48% of the alert transfusions could be considered inappropriate, with hemodynamically stable, asymptomatic anemia being the leading indication. Of clinical services, orthopedic surgery had the highest rate of overriding the alert with no clinical justification (70%). The number of RBC transfusions dropped from 313.5 units per month (preintervention period) to 293.2 units per month (postintervention period)—a 6.5% decrease. Real-time clinical decision support may reduce the number of inappropriate RBC transfusions in a community hospital setting, though in our study, the decrease in blood utilization (6.5%) did not reach statistical significance.

Real-Time Clinical Decision Support at the Point of Care

2019 ◽  
pp. 125-133
Author(s):  
Ana Margarida Pereira ◽  
Cristina Jácome ◽  
Rita Amaral ◽  
Tiago Jacinto ◽  
João A Fonseca
Keyword(s):  
Decision Support ◽  
Real Time ◽  
Clinical Decision Support ◽  
Point Of Care ◽  
Clinical Decision

scholarly journals Reducing Inappropriate Drug Use in Older Patients by Use of Clinical Decision Support in Community Pharmacy: A Mixed-Methods Evaluation

Drugs & Aging ◽  
2019 ◽  
Vol 37 (2) ◽  
pp. 115-123 ◽  
Author(s):  
Linda G. M. Mulder-Wildemors ◽  
Mette Heringa ◽  
Annemieke Floor-Schreudering ◽  
Paul A. F. Jansen ◽  
Marcel L. Bouvy
Keyword(s):  
Decision Support ◽  
Mixed Methods ◽  
Drug Use ◽  
Community Pharmacy ◽  
Clinical Decision Support ◽  
Older Patients ◽  
Clinical Decision ◽  
Inappropriate Drug ◽  
Mixed Methods Evaluation ◽  
Inappropriate Drug Use

Impact of Real-Time Clinical Decision Support on Blood Utilization and Outcomes in Hospitalized Patients with Solid Tumor Cancer

2019 ◽  
Vol 45 (1) ◽  
pp. 57-62
Author(s):  
Kelley N. Wachsberg ◽  
Kevin J. O'Leary ◽  
Ryan Buck ◽  
Lyndsey S. O'Hara ◽  
Jungwha Lee ◽  
...  
Keyword(s):  
Decision Support ◽  
Real Time ◽  
Clinical Decision Support ◽  
Solid Tumor ◽  
Clinical Decision ◽  
Hospitalized Patients ◽  
Blood Utilization

scholarly journals Leveraging the utility of pharmacogenomics in psychiatry through clinical decision support: a focus group study

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Andrew Goodspeed ◽  
Nicolas Kostman ◽  
Trenton E. Kriete ◽  
Joel W. Longtine ◽  
Sean M. Smith ◽  
...  
Keyword(s):  
Decision Support ◽  
Focus Group ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Focus Group Study
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