Improved Prophylaxis and Decreased Rates of Preventable Harm With the Use of a Mandatory Computerized Clinical Decision Support Tool for Prophylaxis for Venous Thromboembolism in Trauma

Haut, Elliott R.; Lau, Brandyn; Kraenzlin, Franca; Hobson, Deborah B.; Kraus, Peggy S.; Carolan, Howard; Haider, Adil H.; Holzmueller, Christine G.; Efron, David T.; Pronovost, Peter J.; Streiff, Michael B.

doi:10.1001/archsurg.2012.2024

Cited by 134 publications

(138 citation statements)

References 33 publications

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“…139,143 • Monitoring for gender bias includes observing for errors, omissions, or deviations from established protocols, standing orders, and national guidelines in our own setting as well as upon receipt of patients from emergency medical services or other facilities.…”

Section: An Unanticipated Breakthrough In Helping To Eliminate Gendermentioning

confidence: 99%

Because Women’s Lives Matter, We Need to Eliminate Gender Bias

2017

Critical Care Nurse

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Using written vignettes of homicides that differed only in sex of perpetrator, forensic psychiatrists and students diagnosed the defendant as legally insane significantly more often when perpetrator was a woman. 11World Health Organization 12 and US 13 research found most behavioral disorders (depression, anxiety) are diagnosed twice as often in women.Men receive more intensive treatments than women for common conditions. 14 85% of men vs 55% of women receive oral antihyperglycemics. 15 Despite the UK NICE guideline 27 13,16 (mandates "urgent referral to an oncologist" for painless macroscopic hematuria), 27% of women vs 10% of men had multiple consults before referral. Bladder cancer 5-year survival rate is 57% for men, 44% for women. 17,18 Female gender is independent risk factor for delayed referral and diagnosis of bladder and renal cancer. 19 TKA referral in patients with comparable osteoarthritis severity: physicians deny sex influences referral, but referral rate for men is 3 times that for women. Using identical standardized patients, 42% of physicians recommended TKA for the male, but not the female. Odds of primary care physicians recommending TKA for men was twice that for women; for orthopedic physicians, odds for men was 22 times that for women. 20Patients with osteoarthritis needing hip replacement, women less likely than men to receive 4 of 5 care stages: consult with general practitioner, specialist referral, orthopedic consult, wait listed. 21 Women have more disability before referral. 22Women have lower probability of referral to waiting list for kidney transplantation and longer delay between dialysis and waiting list compared to men. 23-25Women had significantly lower liver transplantation rates than men from 1997 to 2007 and greater deficit to men since. 26Women had pain years longer than men before referral to pain clinic, where women are prescribed minor tranquilizers, sedatives, or antidepressants vs analgesics and opioids for men. 27After abdominal surgery, physicians prescribed less pain medication for women compared to men; nurses gave less pain medication to women. 28After CABG, men received narcotics, women given sedatives. 29First report on gender attributes of pain: physicians minimized women's pain by attributing it to emotional causes. 30 80 physicians (44 men) and 113 nurses (103 women) more likely to treat male patients with opioids than females. Disparity greater for nurses than physicians. 31Despite ACC/AHA PAD guidelines, at discharge, women are significantly less likely than men to be prescribed 3 recommended therapies: statins, aspirin, and β-blockers. 32,33Women are offered surgical revascularization less often (36.4%) than men (53.8%) and are offered CEA less often at all ages. 34 When CEA is offered to women, it is often on a very delayed basis. Delays persist after adjusting for age, history, preoperative TIA, ABCD2 score, degree of stenosis, unilateral symptoms, and symptomatic stenosis. 34 Findings most concerning because female gender is a known, negative, independ...

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Section: An Unanticipated Breakthrough In Helping To Eliminate Gendermentioning

confidence: 99%

Because Women’s Lives Matter, We Need to Eliminate Gender Bias

2017

Critical Care Nurse

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“…Adult critical care Diagnostic DXplain [28] Mortality and length of stay prediction [9,29] Alert and reminder Ventilator induced lung injury [84] Blood pressure variability while on vasopressors [32] Adverse drug reactions [19] Drug induced thrombocytopenia [30] Epidural hematoma with neuraxial anesthesia [31] Protocol/procedure Acute respiratory distress syndrome [33][34][35] Sepsis [21] VTE prophylaxis and events in trauma patients [37] VTE prophylaxis [38,39] Tidal volume during mechanical ventilation [36] Management…”

Section: Type Of Support Tool Example or Subjectmentioning

confidence: 99%

“…In the prospective cohort study by Bertsche et al [19] , implementation of a CDS program showed significant decreases in drugdrug interactions and in adverse events related to drugdrug interactions, including prolonged QT interval and hypokalemia. Additionally, CDS improves adherence to protocols for mechanical ventilation [33][34][35][36] , sepsis [21] , and venous thromboembolism prevention [37][38][39] , and can improve patient care. Such protocol use in critical care standardizes treatments of common physiologic states and is often central to quality improvement efforts in the ICU [40] .…”

Section: Type Of Support Tool Example or Subjectmentioning

confidence: 99%

Computerized decision support in adult and pediatric critical care

Williams¹,

Bratton²

2013

WJCCM

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Computerized decision support (CDS) is the most advanced form of clinical decision support available and has evolved with innovative technologies to provide meaningful assistance to medical professionals. Critical care clinicians are in unique environments where vast amounts of data are collected on individual patients, and where expedient and accurate decisions are paramount to the delivery of quality healthcare. Many CDS tools are in use today among adult and pediatric intensive care units as diagnostic aides, safety alerts, computerized protocols, and automated recommendations for management. Some CDS use have significantly decreased adverse events and improved costs when carefully implemented and properly operated. CDS tools integrated into electronic health records are also valuable to researchers providing rapid identification of eligible patients, streamlining data-gathering and analysis, and providing cohorts for study of rare and chronic diseases through data-warehousing. Although the need for human judgment in the daily care of critically ill patients has limited the study and realization of meaningful improvements in overall patient outcomes, CDS tools continue to evolve and integrate into the daily workflow of clinicians, and will likely provide advancements over time. Through novel technologies, CDS tools have vast potential for progression and will significantly impact the field of critical care and clinical research in the future.

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“…4,5 DSTs often improve adherence to published guidelines and in many instances improve clinical outcomes, although this has not been universally true. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] However, most research on clinical decision support has focused upon patient management after initial assessment and diagnosis or through mandatory alerts for providers, such as reminders for intraoperative antibiotic prophylaxis, postoperative nausea and vomiting prophylaxis, or proper use of alarms for separate from cardiopulmonary bypass. [26][27][28][29][30][31][32][33][34] In contrast, the use of DSTs for patient assessment/diagnosis and the subsequent application of evidence-based protocols has yet to be rigorously tested.…”

Section: Introductionmentioning

confidence: 99%

Effect of a Cognitive Aid on Adherence to Perioperative Assessment and Management Guidelines for the Cardiac Evaluation of Noncardiac Surgical Patients

Hand

Bridges

Stiegler

et al. 2015

Survey of Anesthesiology

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BACKGROUND-The 2007 American College of Cardiologists/American Heart Association Guidelines on Perioperative Cardiac Evaluation and Care for Noncardiac Surgery is the standard for perioperative cardiac evaluation. Recent work has shown residents and anesthesiologists do not apply these guidelines when tested. This research hypothesized that a decision support tool would improve adherence to this consensus guideline.

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Improved Prophylaxis and Decreased Rates of Preventable Harm With the Use of a Mandatory Computerized Clinical Decision Support Tool for Prophylaxis for Venous Thromboembolism in Trauma

Cited by 134 publications

References 33 publications

Because Women’s Lives Matter, We Need to Eliminate Gender Bias

Because Women’s Lives Matter, We Need to Eliminate Gender Bias

Computerized decision support in adult and pediatric critical care

Effect of a Cognitive Aid on Adherence to Perioperative Assessment and Management Guidelines for the Cardiac Evaluation of Noncardiac Surgical Patients

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