Retrospective analysis of the impact of electronic medical record alerts on low value care in a pediatric hospital.
J Am Med Inform Assoc
; 31(3): 600-610, 2024 Feb 16.
Article
em En
| MEDLINE
| ID: mdl-38078841
ABSTRACT
OBJECTIVES:
Hospital costs continue to rise unsustainably. Up to 20% of care is wasteful including low value care (LVC). This study aimed to understand whether electronic medical record (EMR) alerts are effective at reducing pediatric LVC and measure the impact on hospital costs. MATERIALS ANDMETHODS:
Using EMR data over a 76-month period, we evaluated changes in 4 LVC practices following the implementation of EMR alerts, using time series analysis to control for underlying time-based trends, in a large pediatric hospital in Australia. The main outcome measure was the change in rate of each LVC practice. Balancing measures included the rate of alert adherence as a proxy measure for risk of alert fatigue. Hospital costs were calculated by the volume of LVC avoided multiplied by the unit costs. Costs of the intervention were calculated from clinician and analyst time required.RESULTS:
All 4 LVC practices showed a statistically significant reduction following alert implementation. Two LVC practices (blood tests) showed an abrupt change, associated with high rates of alert adherence. The other 2 LVC practices (bronchodilator use in bronchiolitis and electrocardiogram ordering for sleeping bradycardia) showed an accelerated rate of improvement compared to baseline trends with lower rates of alert adherence. Hospital savings were $325 to $180â000 per alert. DISCUSSION ANDCONCLUSION:
EMR alerts are effective in reducing pediatric LVC practices and offer a cost-saving opportunity to the hospital. Further efforts to leverage EMR alerts in pediatric settings to reduce LVC are likely to support future sustainable healthcare delivery.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Sistemas de Registro de Ordens Médicas
/
Registros Eletrônicos de Saúde
Idioma:
En
Ano de publicação:
2024
Tipo de documento:
Article