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Orientation in Perpetuity: An Online Clinical Decision Support System for Surgical Residents. | LitMetric

AI Article Synopsis

  • Limiting variability in clinical care is important for quality improvement, and frequent turnover of residents can hinder standardization; therefore, a clinical decision support system (CDSS) was introduced to assist trainees in accessing up-to-date guidelines and protocols.
  • A web-based CDSS was developed for a pediatric surgery service, accompanied by standardized orientation for new trainees, and usage was monitored through web analytics; surveys were conducted to gauge residents' attitudes and confidence in patient management before and after CDSS implementation.
  • Over 14 months, the CDSS included 33 clinical guidelines and 207 educational documents, achieving high utilization rates with an average of 4.0 weekly page views per trainee, and feedback indicated positive responses from rotating residents regarding the resource

Article Abstract

Background: Limiting variability is an essential element to improving quality of care. Frequent resident turnover represents a significant barrier to clinical standardization. Trainees joining new surgical services must familiarize themselves with the guidelines and protocols that direct patient care as well as their learning objectives and expectations. A clinical decision support system (CDSS) is a dynamic, searchable electronic resource intended for use at the point of care. The CDSS can provide convenient and timely access to relevant information for residents, allowing them to incorporate the most up-to-date protocols and guidelines in their daily care of patients. The objective of this quality improvement intervention was to determine the objective rate of CDSS utilization and its subjective value to residents.

Materials And Methods: An internally developed, web-based CDSS including essential, clinically useful documents was created for use by trainees on a busy pediatric surgery service. A standardized orientation was provided to each resident and fellow on joining the service, complemented by a summary card to be attached to the trainee's ID badge. CDSS usage was monitored using web analytics. Trainees who rotated before and after the CDSS launch were surveyed regarding attitudes toward clinical resources and confidence in patient management.

Results: Documents published to the CDSS included 33 clinical guideline documents and 207 additional educational and support files including reference materials from service orientation were made available to trainees and staff. Goals for resident usage were established by evaluation and adaptation of early traffic patterns. Analysis of web traffic collected over 14 consecutive months revealed utilization above target levels, with 4.0 average weekly page views per trainee (IQR: 1.6-5.6). A total of 60 survey responses were received (54% of trainees invited); majorities of rotating trainees and survey respondents were trainees in general surgery and most were interns. Mean composite scores reflected a trend toward improved satisfaction when seeking CDSM (before intervention 3.18 [SD 0.73], after intervention 3.92 [SD 0.70], range 1-5) which was statistically significant (P = 0.005). Mean scores also improved across five of six components of the composite score (mean improvement 0.75, range: 0.53-0.92), four of which were statistically significant (P = 0.001-0.038). Most (59%) respondents reported that they used the CDSS frequently.

Conclusions: Convenient access to a CDSS resulted in greater than expected utilization as well as higher resident satisfaction with and confidence in materials provided. A CDSS is a promising tool offering quick access to high-quality information in challenging trainee environments.

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Source
http://dx.doi.org/10.1016/j.jss.2019.05.063DOI Listing

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