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- Title
Using Clinical Decision Support to Reduce Inappropriate Imaging: A Health Care Improvement Case Study.
- Authors
Jones, Emily B.; Swain, Matthew; Burdick, Twila
- Abstract
* Objective: Clinical decision support (CDS) can be a useful tool to decrease inappropriate imaging by providing evidence-based information to clinicians at the point of care. The objective of this case study is to highlight lessons from a health care improvement initiative using CDS to encourage use of ultrasound rather than computed tomography (CT) scans as an initial diagnostic tool for suspected appendicitis in pediatric patients. * Methods: The percentage of suspected pediatric appendicitis cases receiving ultrasounds and CT scans was calculated using electronic health record data. Four steps for implementing health information technology were identified in a literature scan that guided data collection and analysis: planning, software customization and workflow design, training and user support, and optimization. * Results: During the fourth quarter of 2010, 1 in 7 pediatric patients with suspected appendicitis received an ultrasound and almost half received a CT scan. By the first quarter of 2012, ultrasounds were performed in 40.8% of these cases and the use of CT scans declined to 39.9% of suspected pediatric appendicitis cases. * Conclusion: Four lessons emerged. First, all levels of staff should be involved in the planning process to make organizational priorities actionable and build buy-in for each healthcare improvement initiative. Second, it takes time to design and test the alert to ensure that clinical guidelines are being properly applied. Third, re-engineering the workflow is critical for usability; in this case, ensuring the availability of ultrasound staff was particularly important. Finally, the effectiveness of CDS depends on applying relevant evidence-based practice guidelines to real-time patient data.
- Subjects
APPENDICITIS diagnosis; APPENDICITIS; COMPUTED tomography; DECISION support systems; INFORMATION storage &; retrieval systems; MEDICAL databases; QUALITY assurance; HUMAN services programs; ELECTRONIC health records; DESCRIPTIVE statistics; CHILDREN
- Publication
Journal of Clinical Outcomes Management, 2017, Vol 24, Issue 11, p501
- ISSN
1079-6533
- Publication type
Article