Applied clinical informatics
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To compare the completeness of Emergency Department (ED) discharge instructions before and after introduction of an electronic discharge instructions module by scoring compliance with the Centers for Medicare and Medicaid Services (CMS) Outpatient Measure 19 (OP-19). ⋯ With careful design, information technology can improve the completeness of ED patient discharge instructions and performance on the OP-19 quality measure.
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Patient and surgical case complexity are important considerations in creating appropriate clinical assignments for trainees in the operating room (OR). The American Society of Anesthesiologists (ASA) Physical Status Classification System is the most commonly used tool to classify patient illness severity, but it requires manual evaluation by a clinician and is highly variable. A Risk Stratification System for surgical patients was recently published which uses administrative billing codes to calculate four Risk Stratification Indices (RSIs) and provides an objective surrogate for patient complexity that does not require clinical evaluation. This risk score could be helpful when assigning operating room cases. ⋯ We have shown that it is possible to create a web-based tool that uses existing billing data to automatically calculate risk scores for patients scheduled to undergo surgery. Such a risk scoring system could be used to match patient acuity to physician experience, and to provide improved patient and clinician experiences. The web tool could be improved by expanding the input database or utilizing procedure booking codes rather than billing data.
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Antimicrobial stewardship programs (ASPs) help meet quality and safety goals with regard to antimicrobial use. Prior to CPOE implementation, the ASP at our pediatric tertiary hospital developed a paper-based order set containing recommendations for optimization of dosing. In adapting our ASP for CPOE, we aimed to preserve consistency in our ASP recommendations and expand ASP expertise to other hospitals in our health system. ⋯ Well-defined ASP recommendations and modular design strengthened successful CPOE implementation, as well as the adoption of specialized pediatric ASP expertise with other facilities.
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Poor usability is a threat to patient safety and linked to productivity loss, workflow disruption, user frustration, sub-optimal product use and system de-installations. Although usability is receiving more attention nationally and internationally, myths about usability persist. This editorial debunks five common myths about usability (1) usability only concerns the look and feel of a product and is, therefore, only a minor concern, (2) usability is not measurable, (3) usability stifles innovation, (4) vendors are solely responsible for product usability, and (5) usability methods are not practical for use in healthcare.
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Electronic health record systems used in conjunction with clinical decision support (CDS) or computerized provider order entry (CPOE) have shown potential in improving quality of care, yet less is known about the effects of combination use of CDS and CPOE on prescribing rates at discharge. ⋯ Although associations found between full implementation of CDS and appropriate prescribing rates suggest that clinical decision tools are sufficient compared to basic EHR systems in improving prescribing at discharge, the modest differences raise doubt about the clinical relevance of the findings. Future studies need to continue investigating the causal nature and clinical relevance of these associations.