Clinical Decision Support Reduces Unnecessary Tetanus Vaccinations in the Emergency Department

Dutta, Sayon; McEvoy, Dustin; Stump, Timothy E.; McCabe, Jonathan; Mahendra-Rajah, Anoushka; McMurry, Reid; White, Benjamin; Rubins, David

doi:10.1016/j.annemergmed.2021.02.021

Cited by 6 publications

(4 citation statements)

References 22 publications

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“…Two studies increased ketorolac prescribing 103 or decreased excessive dosing 104 in renal impairment. Dutta et al 105 alerted physicians of duplicate vaccines. Bernstein et al 106 reduced the use of proprietary antibiotics by displaying patients’ insurance status.…”

Section: Resultsmentioning

confidence: 99%

The role of information systems in emergency department decision-making—a literature review

Born,

Schwarz,

Böttcher

et al. 2024

Journal of the American Medical Informatics Association

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Objectives Healthcare providers employ heuristic and analytical decision-making to navigate the high-stakes environment of the emergency department (ED). Despite the increasing integration of information systems (ISs), research on their efficacy is conflicting. Drawing on related fields, we investigate how timing and mode of delivery influence IS effectiveness. Our objective is to reconcile previous contradictory findings, shedding light on optimal IS design in the ED. Materials and methods We conducted a systematic review following PRISMA across PubMed, Scopus, and Web of Science. We coded the ISs’ timing as heuristic or analytical, their mode of delivery as active for automatic alerts and passive when requiring user-initiated information retrieval, and their effect on process, economic, and clinical outcomes. Results Our analysis included 83 studies. During early heuristic decision-making, most active interventions were ineffective, while passive interventions generally improved outcomes. In the analytical phase, the effects were reversed. Passive interventions that facilitate information extraction consistently improved outcomes. Discussion Our findings suggest that the effectiveness of active interventions negatively correlates with the amount of information received during delivery. During early heuristic decision-making, when information overload is high, physicians are unresponsive to alerts and proactively consult passive resources. In the later analytical phases, physicians show increased receptivity to alerts due to decreased diagnostic uncertainty and information quantity. Interventions that limit information lead to positive outcomes, supporting our interpretation. Conclusion We synthesize our findings into an integrated model that reveals the underlying reasons for conflicting findings from previous reviews and can guide practitioners in designing ISs in the ED.

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Section: Resultsmentioning

confidence: 99%

The role of information systems in emergency department decision-making—a literature review

Born,

Schwarz,

Böttcher

et al. 2024

Journal of the American Medical Informatics Association

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“…Clinical decision support systems aid providers in administering accurate and timely vaccinations in accordance with Advisory Committee on Immunization Practices (ACIP) recommendations. Four articles demonstrated that implementation of a clinical decision support functional component, such as forecasting and prompting recommended vaccinations for patients, reduced the administration of unnecessary vaccinations and increased vaccination rates [ 21 , 22 , 23 , 24 ]. However, according to an assessment conducted by the American Immunization Registry Association (AIRA) in 2021, only 51% of jurisdictional IIS included in the assessment met the twelve criteria necessary for clinical decision support [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

“…The number of potentially unnecessary tetanus vaccine administrations in a baseline phase versus post-intervention Significant decrease in 1 out of 1 outcomes [21] Over-immunization with a second influenza vaccine dose Qualitative support for decrease [22] Overvaccination/vaccination duplication Qualitative support for decrease [13] Immunization accuracy…”

Section: Unnecessary Vaccinations or Overvaccinationmentioning

confidence: 99%

Understanding Diversity of Policies, Functionalities, and Operationalization of Immunization Information Systems and Their Impact: A Targeted Review of the Literature

Donckels¹,

Cunniff

Regenold³

et al. 2023

Vaccines

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The COVID-19 pandemic has focused attention on the use of immunization information systems (IIS) to record and consolidate immunization records from a variety of sources to generate comprehensive patient immunization histories. Operationalization of IIS in the United States is decentralized, and as such, there are over 60 different IIS with wide variations in enabling policies and functionalities. As such, the policies that inform the development and operation of those sub-national IIS exist at the state and sometimes city levels. A targeted literature review was conducted to identify IIS policies and functionalities and assess their impact. The authors identified articles published from 2012 to 2022 that discussed or evaluated IIS policies and functionalities and screened titles, abstracts, and full text for inclusion. When selected for inclusion, authors extracted IIS policy/functionality characteristics and qualitative or quantitative outcomes of their implementation, where applicable. The search terms yielded 86 articles, of which 39 were included in the analysis. The articles were heterogeneous with respect to study design, interventions, outcomes, and effect measures. Out of the 17 IIS policies and functional components identified in the targeted literature review, the most commonly evaluated were provider-based patient reminder/recall, IIS-based centralized reminder/recall, and clinical decision support. Patient reminder/recall had the most published research and was associated with increased vaccination rates and vaccine knowledge. Despite the lack of quantitative evidence, there is a consensus that immunization data interoperability is critical to supporting IIS data quality, access, and exchange. Significant evidence gaps remain about the effectiveness of IIS functionalities and policies. Future research should evaluate the impact of policies and functionalities to guide improved utilization of IIS, increase national interoperability and standardization, and ultimately improve vaccination coverage and population health.

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“…Oluoch et al, [3] Stephens et al, [4] Solberg et al, [5] Rizk et al, [6] Orenstein et al, [7] Zakim et al, [8] Andruchow et al, [9] Seol et al, [10] Orenstein et al, [11] Dente et al, [12] Dutta et al, [13] Austrian et al, [14] Saegerman et al, [15] Title interventions. In the second paper, Dutta et al, [13] described the implementation of a CDS alert in an electronic health record to warn providers about a previously documented tetanus vaccine, when they are ordering a new one. here, the authors explored the alert efficacy to reduce unnecessary vaccines in the Emergency Department (ED).…”

Section: Referencementioning

confidence: 99%

Clinical Decision Support Systems: Contributions from 2021

Borbolla

Colicchio

2022

Yearb Med Inform

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Objectives: To summarize significant research contributions published in 2021 in the field of clinical decision support (CDS) systems and select the best papers for the Decision Support section of the International Medical Informatics Association (IMIA) Yearbook. Methods: The authors searched the MEDLINE® database for papers focused on clinical decision support (CDS) systems. From search results, section editors established a list of candidate best papers, which were then peer-reviewed by at least three external reviewers. The IMIA Yearbook editorial committee selected the best papers on the basis of all reviews including the section editors’ evaluation. Results: A total of 337 articles were retrieved from which 13 candidate papers were identified. Finally, from the candidate papers, the top three papers were selected. The first paper introduces an innovative evaluation approach to CDS systems, the second compares six health institutions on how they are measuring CDS alert fatigue and the last one adds new evidence on how CDS can help to reduce unnecessary interventions.

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Clinical Decision Support Reduces Unnecessary Tetanus Vaccinations in the Emergency Department

Cited by 6 publications

References 22 publications

The role of information systems in emergency department decision-making—a literature review

The role of information systems in emergency department decision-making—a literature review

Understanding Diversity of Policies, Functionalities, and Operationalization of Immunization Information Systems and Their Impact: A Targeted Review of the Literature

Clinical Decision Support Systems: Contributions from 2021

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