• Brian W Patterson, Michael S Pulia, Shashank Ravi, Hoonakker Peter L T PLT Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, WI., Schoofs Hundt Ann A Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, WI., Douglas Wiegmann, Emily J Wirkus, Stephen Johnson, and Pascale Carayon.
• BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI; Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, WI. Electronic address: bpatter@medicine.wisc.edu.
• Ann Emerg Med. 2019 Aug 1; 74 (2): 285-296.

Study ObjectiveAs electronic health records evolve, integration of computerized clinical decision support offers the promise of sorting, collecting, and presenting this information to improve patient care. We conducted a systematic review to examine the scope and influence of electronic health record-integrated clinical decision support technologies implemented in the emergency department (ED).MethodsA literature search was conducted in 4 databases from their inception through January 18, 2018: PubMed, Scopus, the Cumulative Index of Nursing and Allied Health, and Cochrane Central. Studies were included if they examined the effect of a decision support intervention that was implemented in a comprehensive electronic health record in the ED setting. Standardized data collection forms were developed and used to abstract study information and assess risk of bias.ResultsA total of 2,558 potential studies were identified after removal of duplicates. Of these, 42 met inclusion criteria. Common targets for clinical decision support intervention included medication and radiology ordering practices, as well as more comprehensive systems supporting diagnosis and treatment for specific disease entities. The majority of studies (83%) reported positive effects on outcomes studied. Most studies (76%) used a pre-post experimental design, with only 3 (7%) randomized controlled trials.ConclusionNumerous studies suggest that clinical decision support interventions are effective in changing physician practice with respect to process outcomes such as guideline adherence; however, many studies are small and poorly controlled. Future studies should consider the inclusion of more specific information in regard to design choices, attempt to improve on uncontrolled before-after designs, and focus on clinically relevant outcomes wherever possible.Copyright © 2018 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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