Improving adherence to asthma clinical guidelines and discharge documentation from emergency departments: Implementation of a dynamic and integrated electronic decision support system†

Kwok, Raymond; Dinh, Michael; Dinh, David; Chu, Matthew

doi:10.1111/j.1742-6723.2008.01149.x

Cited by 51 publications

(30 citation statements)

References 16 publications

(33 reference statements)

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“…[5][6][7][8] Multiple quality improvement (QI) efforts to improve inpatient asthma care for children have been reported, but a positive impact on asthma outcomes is often not demonstrated. 3,[9][10][11][12][13][14][15][16][17][18] No data exist about the sustainability or long-term impact of QI interventions. Furthermore, most of the successful pediatric inpatient asthma interventions are implemented at a tertiary care pediatric centers, with little information available about dissemination to community hospitals.…”

mentioning

confidence: 99%

Improving Pediatric Asthma Care and Outcomes Across Multiple Hospitals

et al. 2015

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BACKGROUND AND OBJECTIVES: Gaps exist in inpatient asthma care. Our aims were to assess the impact of an evidence-based care process model (EB-CPM) 5 years after implementation at Primary Children's Hospital (PCH), a tertiary care facility, and after its dissemination to 7 community hospitals.METHODS: Participants included asthmatics 2 to 17 years admitted at 8 hospitals between 2003 and 2013. The EB-CPM was implemented at PCH between January 2008 and March 2009, then disseminated to 7 community hospitals between January and June 2011. We measured compliance using a composite score (CS) for 8 quality measures. Outcomes were compared between preimplementation and postimplementation periods. Confounding was addressed through multivariable regression analyses.RESULTS: At PCH, the CS increased and remained at .90% for 5 years after implementation. We observed sustained reductions in asthma readmissions (P = .026) and length of stay (P , .001), a trend toward reduced costs (P = .094), and no change in hospital resource use, ICU transfers, or deaths. The CS also increased at the 7 community hospitals, reaching 80% to 90% and persisting .2 years after dissemination, with a slight but not significant readmission reduction (P = .119), a significant reduction in length of stay (P , .001) and cost (P = .053), a slight increase in hospital resource use (P = .032), and no change in ICU transfers or deaths.CONCLUSIONS: Our intervention resulted in sustained, long-term improvement in asthma care and outcomes at the tertiary care hospital and successful dissemination to community hospitals.

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confidence: 99%

Improving Pediatric Asthma Care and Outcomes Across Multiple Hospitals

et al. 2015

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“…[16][17][18][19][20][21]23,24,31 This project did show promising results for using evidence-based flowsheets based on five of six stroke management goals, whereas the use of clinical decision support revealed insignificant results due to notable limitations. The impact of evidence-based nursing documentation flowsheets and clinical decision support reminders should continue to be measured for influence on the quality of nursing documentation and ultimately improve patient outcomes.…”

Section: Resultsmentioning

confidence: 96%

“…14 The EHR must also be optimized to incorporate standardized documentation systems with evidence-based clinical practice guidelines, clinical decision support, and other clinically important documentation variables that can assist decision making. 13,[15][16][17][18] Structured documentation templates for capturing data have also been shown to improve overall data quality by producing nursing documentation that is more complete, relevant, and comprehensive. [19][20][21] Several studies have evaluated the effectiveness of computerized documentation templates, merged with disease-specific content, to help standardize clinician documentation.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Nursing Documentation Completion of Stroke Patients in the Emergency Department

Richardson

Sengstack

Doucette

et al. 2016

CIN: Computers, Informatics, Nursing

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The primary aim of this performance improvement project was to determine whether the electronic health record implementation of stroke-specific nursing documentation flowsheet templates and clinical decision support alerts improved the nursing documentation of eligible stroke patients in seven stroke-certified emergency departments. Two system enhancements were introduced into the electronic record in an effort to improve nursing documentation: disease-specific documentation flowsheets and clinical decision support alerts. Using a pre-post design, project measures included six stroke management goals as defined by the National Institute of Neurological Disorders and Stroke and three clinical decision support measures based on entry of orders used to trigger documentation reminders for nursing: (1) the National Institutes of Health's Stroke Scale, (2) neurological checks, and (3) dysphagia screening. Data were reviewed 6 months prior (n = 2293) and 6 months following the intervention (n = 2588). Fisher exact test was used for statistical analysis. Statistical significance was found for documentation of five of the six stroke management goals, although effect sizes were small. Customizing flowsheets to meet the needs of nursing workflow showed improvement in the completion of documentation. The effects of the decision support alerts on the completeness of nursing documentation were not statistically significant (likely due to lack of order entry). For example, an order for the National Institutes of Health Stroke Scale was entered only 10.7% of the time, which meant no alert would fire for nursing in the postintervention group. Future work should focus on decision support alerts that trigger reminders for clinicians to place relevant orders for this population.

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“…One approach for effectively integrating clinical practice guidelines into medical practice is the use of CDSS. The use of CDSS has facilitated clinicians' adherence to clinical practice guidelines, thereby improving patient outcomes (Kotze & Brdaroska, 2004;Kwok, Dinh, Dinh, & Chu, 2009). Kotze and Brdaroska (2004) noted that the "ability of computers to store, search and sort large volumes of data rapidly, as well as the everexpanding knowledge, access and use of computers, have paved the way for the incorporation of clinical practice guidelines into computer-based decision support systems" (p. 362).…”

Section: Clinical Practice Guidelinementioning

confidence: 99%

“…The encoded rules in the clinical practice guidelines provide the framework in which programming rules are encoded and used in the development of CDSS. For example, Kwok et al (2009) found that the use of an integrated and dynamic electronic decision support system (EDSS) at a single emergency department promoted strict adherence to asthma clinical guidelines and improved clinical documentation and discharge management plans for asthma management. It is in this regard that Kotze and Brdaroska (2004) indicated that CDSS are "crucial elements in long-term strategies for promoting the use of clinical practice guidelines" (p. 362).…”

Section: Clinical Practice Guidelinementioning

confidence: 99%

Impacts and Risks of Adopting Clinical Decision Support Systems

Bonney¹

2011

Efficient Decision Support Systems - Practice and Challenges in Biomedical Related Domain

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Improving adherence to asthma clinical guidelines and discharge documentation from emergency departments: Implementation of a dynamic and integrated electronic decision support system†

Cited by 51 publications

References 16 publications

Improving Pediatric Asthma Care and Outcomes Across Multiple Hospitals

Improving Pediatric Asthma Care and Outcomes Across Multiple Hospitals

Evaluation of Nursing Documentation Completion of Stroke Patients in the Emergency Department

Impacts and Risks of Adopting Clinical Decision Support Systems

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