Objectives: To improve clinical decision support (CDS) by allowing users to provide real-time feedback when they interact with CDS tools and by creating processes for responding to and acting on this feedback.
Methods: Two organizations implemented similar real-time feedback tools and processes in their electronic health record and gathered data over a 30-month period. At both sites, users could provide feedback by using Likert feedback links embedded in all end-user facing alerts, with results stored outside the electronic health record, and provide feedback as a comment when they overrode an alert.
Importance: The rapid transition to virtual health care has depended on physician and patient abilities to adopt new technology and workflows. Physicians transitioning more slowly or not at all could result in access challenges for their patients.
Objective: To identify physician characteristics associated with the transition to virtual health care in a large regional health care system.
The COVID-19 pandemic has created unique challenges for the U.S. healthcare system due to the staggering mismatch between healthcare system capacity and patient demand.
View Article and Find Full Text PDFObjectives: Documentation of allergies in a coded, non-free-text format in the electronic health record (EHR) triggers clinical decision support to prevent adverse events. Health system-wide patient safety initiatives to improve EHR allergy documentation by specifically decreasing free-text allergy entries have not been reported. The goal of this initiative was to systematically reduce free-text allergen entries in the EHR allergy module.
View Article and Find Full Text PDFStud Health Technol Inform
August 2019
Compared to other laboratory data, microbiology data are a complex mix of quantitative and qualitative results that return iteratively over time. Commercial electronic health records (EHR) frequently have limitations in the manner in which they manage microbiology data, not attempting to codify data but rather displaying it as text. This contributes to time-consuming and error-prone clinical workflows.
View Article and Find Full Text PDFStud Health Technol Inform
August 2019
Electronic health records (EHRs) have been shown to improve safety and quality. However, usability and safety issues with EHRs have been reported. The current state of the art in usability testing is to have clinicians conduct simulated activities in a usability lab.
View Article and Find Full Text PDFStud Health Technol Inform
August 2019
Clinical decision support systems (CDSS) are widely used to improve patient care and guide workflow. End users can be valuable contributors to monitoring for CDSS malfunctions. However, they often have little means of providing direct feedback on the design and build of such systems.
View Article and Find Full Text PDFClinical decision support (CDS) systems are prevalent in electronic health records and drive many safety advantages. However, CDS systems can also cause unintended consequences. Monitoring programs focused on alert firing rates are important to detect anomalies and ensure systems are working as intended.
View Article and Find Full Text PDFBackground: Microbiology laboratory results are complex and cumbersome to review. We sought to develop a new review tool to improve the ease and accuracy of microbiology results review.
Methods: We observed and informally interviewed clinicians to determine areas in which existing microbiology review tools were lacking.
Objective: To develop and test an instrument for assessing a healthcare organization's ability to mitigate malpractice risk through clinical decision support (CDS).
Materials And Methods: Based on a previously collected malpractice data set, we identified common types of CDS and the number and cost of malpractice cases that might have been prevented through this CDS. We then designed clinical vignettes and questions that test an organization's CDS capabilities through simulation.
Infect Control Hosp Epidemiol
September 2014
Electronic surveillance for healthcare-associated infections (HAIs) is increasingly widespread. This is driven by multiple factors: a greater burden on hospitals to provide surveillance data to state and national agencies, financial pressures to be more efficient with HAI surveillance, the desire for more objective comparisons between healthcare facilities, and the increasing amount of patient data available electronically. Optimal implementation of electronic surveillance requires that specific information be available to the surveillance systems.
View Article and Find Full Text PDFAs providers and systems move towards meaningful use of electronic health records, the once distant vision of data reuse for automated quality reporting may soon become a reality. To facilitate consistent and reliable reporting and benchmarking beyond the local level, standardization of both electronic health record content and quality measures is needed at the concept level. This degree of standardization requires local and national advancement and coordination.
View Article and Find Full Text PDFObjective: Spread of multidrug-resistant organisms within the intensive care unit (ICU) results in substantial morbidity and mortality. Novel strategies are needed to reduce transmission. This study sought to determine if the use of daily chlorhexidine bathing would decrease the incidence of colonization and bloodstream infections (BSI) because of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) among ICU patients.
View Article and Find Full Text PDFInvasive disease following methicillin-resistant Staphylococcus aureus (MRSA) detection is common, regardless of whether initial detection involves colonization or infection. We assessed the genetic relatedness of isolates obtained > or =2 weeks apart representing either repeated infections or colonization-infection sets to determine if infections are likely to be caused by previously harbored strains. We found that MRSA infection following initial colonization or infection is caused by the same strain in most cases, suggesting that a single successful attempt at decolonization may prevent the majority of later infection.
View Article and Find Full Text PDFBloodstream infection caused by vancomycin-resistant enterococcus (VRE) is associated with very high mortality among allogeneic hematopoietic stem cell transplant (alloHSCT) recipients. However, it remains unclear whether VRE bloodstream infection directly causes mortality in the early posttransplant period or is simply a marker of poor outcome. To determine the risk factors for VRE bloodstream infection and its effect on outcome, we followed 92 patients screened for stool colonization by VRE upon admission for alloHSCT.
View Article and Find Full Text PDFInfect Control Hosp Epidemiol
July 2006
Background: Education-based interventions can reduce the incidence of catheter-associated bloodstream infection. The generalizability of findings from single-center studies is limited.
Objective: To assess the effect of a multicenter intervention to prevent catheter-associated bloodstream infections.
Objective: To determine the extent to which evidence-based practices for the prevention of central venous catheter (CVC)-associated bloodstream infections are incorporated into the policies and practices of academic intensive care units (ICUs) in the United States and to determine variations in the policies on CVC insertion, use, and care.
Design: A 9-page written survey of practices and policies for nontunneled CVC insertion and care.
Setting: ICUs in 10 academic tertiary-care hospitals.