eSIMPLER: A Dynamic, Electronic Health Record-Integrated Checklist for Clinical Decision Support During PICU Daily Rounds.
Pediatr Crit Care Med
; 22(10): 898-905, 2021 10 01.
Article
in En
| MEDLINE
| ID: mdl-33935271
ABSTRACT
OBJECTIVES:
Design, implement, and evaluate a rounding checklist with deeply embedded, dynamic electronic health record integration.DESIGN:
Before-after quality-improvement study.SETTING:
Quaternary PICU in an academic, free-standing children's hospital. PATIENTS All patients in the PICU during daily morning rounds.INTERVENTIONS:
Implementation of an updated dynamic checklist (eSIMPLER) providing clinical decision support prompts with display of relevant data automatically pulled from the electronic health record. MEASUREMENTS AND MAINRESULTS:
The prior daily rounding checklist, eSIMPLE, was implemented for 49,709 patient-days (7,779 patients) between October 30, 2011, and October 7, 2018. eSIMPLER was implemented for 5,306 patient-days (971 patients) over 6 months. Checklist completion rates were similar (eSIMPLE 95% [95% CI, 88-98%] vs eSIMPLER 98% [95% CI, 92-100%] of patient-days; p = 0.40). eSIMPLER required less time per patient (28 ± 1 vs 47 ± 24 s; p < 0.001). Users reported improved satisfaction with eSIMPLER (p = 0.009). Several checklist-driven process measures-discordance between electronic health record orders for stress ulcer prophylaxis and user-recorded indication for stress ulcer prophylaxis, rate of venous thromboembolism prophylaxis prescribing, and recognition of reduced renal function-improved during the eSIMPLER phase.CONCLUSIONS:
eSIMPLER, a dynamic, electronic health record-informed checklist, required less time to complete and improved certain care processes compared with a prior, static checklist with limited electronic health record data. By focusing on the "Five Rights" of clinical decision support, we created a well-accepted clinical decision support tool that was integrated efficiently into daily rounds. Generalizability of eSIMPLER's effectiveness and its impact on patient outcomes need to be examined.
Full text:
1
Database:
MEDLINE
Main subject:
Decision Support Systems, Clinical
/
Teaching Rounds
Type of study:
Prognostic_studies
Limits:
Child
/
Humans
Language:
En
Year:
2021
Type:
Article