Clinical Trial of Standing-Orders Strategies to Increase the Inpatient Influenza Vaccination Rate

Trick, William E.; Das, Krishna Priyadarshini; Gerard, Mary; Charles‐Damte, Marjorie; Murphy, Gregory A.; Benson, Irene; Morita, Julie

doi:10.1086/593121

Cited by 15 publications

(17 citation statements)

References 7 publications

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“…Perhaps this opt-in approach is less effective. 23,31 There were several limitations to our study. First, our baseline data collection required paper chart review, wherein there was no prompt to document VTE risk stratification (which is shown by the 3% documentation rate of VTE risk assessment).…”

Section: Potentially Preventable Vte Eventsmentioning

confidence: 97%

Improved Prophylaxis and Decreased Rates of Preventable Harm With the Use of a Mandatory Computerized Clinical Decision Support Tool for Prophylaxis for Venous Thromboembolism in Trauma

et al. 2012

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Venous thromboembolism is associated with substantial morbidity and mortality and is largely preventable. Despite this fact, appropriate prophylaxis is vastly underutilized. To improve compliance with best practice prophylaxis for VTE in hospitalized trauma patients, we implemented a mandatory computerized provider order entry-based clinical decision support tool. The system required completion of checklists of VTE risk factors and contraindications to pharmacologic prophylaxis. With this tool, we were able to determine a patient's risk stratification level and recommend appropriate prophylaxis. To evaluate the effect of our mandatory computerized provider order entry-based clinical decision support tool on compliance with prophylaxis guidelines for venous thromboembolism (VTE) and VTE outcomes among admitted adult trauma patients.

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Section: Potentially Preventable Vte Eventsmentioning

confidence: 97%

Improved Prophylaxis and Decreased Rates of Preventable Harm With the Use of a Mandatory Computerized Clinical Decision Support Tool for Prophylaxis for Venous Thromboembolism in Trauma

et al. 2012

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“…From the 830 articles returned from the database searches and a further 4 articles from manual reference searching, we included 19 original research articles. Two articles reported on the same study 26 , 27 ; with a final number of 18 included studies. Overall, the studies evaluated the impact of 24 nudge interventions within the EHR on care delivery (see PRISMA Flow Diagram in Figure 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…Five studies implemented multiple nudge interventions. 26 , 27 , 35 , 36 , 38 , 44 Twelve interventions aimed to improve medication or fluid use 26–28 , 35 , 40–44 ; 9 interventions to improve laboratory test ordering 29 , 31 , 32 , 34 , 36 , 38 , 39 ; 2 interventions to improve appropriate care 33 , 37 ; and 1 to improve imaging. 30 Overall, studies used 5 of the 9 nudge interventions listed in the taxonomy applied: (1) change choice defaults ( n = 9 interventions); (2) make information more visible ( n = 6 interventions); (3) change range or composition of options ( n = 5 interventions); (4) make information more or less salient ( n = 2 interventions); and (5) change option-related effort ( n = 2 interventions).…”

Section: Resultsmentioning

confidence: 99%

Effectiveness of non-interruptive nudge interventions in electronic health records to improve the delivery of care in hospitals: a systematic review

Raban

Gates

Gamboa

et al. 2023

Journal of the American Medical Informatics Association

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Objectives To describe the application of nudges within electronic health records (EHRs) and their effects on inpatient care delivery, and identify design features that support effective decision-making without the use of interruptive alerts. Materials and methods We searched Medline, Embase, and PsychInfo (in January 2022) for randomized controlled trials, interrupted time-series and before–after studies reporting effects of nudge interventions embedded in hospital EHRs to improve care. Nudge interventions were identified at full-text review, using a pre-existing classification. Interventions using interruptive alerts were excluded. Risk of bias was assessed using the ROBINS-I tool (Risk of Bias in Non-randomized Studies of Interventions) for non-randomized studies or the Cochrane Effective Practice and Organization of Care Group methodology for randomized trials. Study results were summarized narratively. Results We included 18 studies evaluating 24 EHR nudges. An improvement in care delivery was reported for 79.2% (n = 19; 95% CI, 59.5–90.8) of nudges. Nudges applied were from 5 of 9 possible nudge categories: change choice defaults (n = 9), make information visible (n = 6), change range or composition of options (n = 5), provide reminders (n = 2), and change option-related effort (n = 2). Only one study had a low risk of bias. Nudges targeted ordering of medications, laboratory tests, imaging, and appropriateness of care. Few studies evaluated long-term effects. Discussion Nudges in EHRs can improve care delivery. Future work could explore a wider range of nudges and evaluate long-term effects. Conclusion Nudges can be implemented in EHRs to improve care delivery within current system capabilities; however, as with all digital interventions, careful consideration of the sociotechnical system is crucial to enhance their effectiveness.

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“…Most of these studies used computer-decision support models to increase vaccination compliance. In these models, standing orders have been shown to be the most effective 14. The ACIP has long encouraged standing orders to be used in inpatient settings 15.…”

Section: Discussionmentioning

confidence: 99%

Influenza vaccination rates for hospitalised patients: a multiyear quality improvement effort

et al. 2015

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Although we are confident that our local efforts helped to improve the vaccination rate, external factors such as the 2009 H1N1 pandemic and universal vaccination may have primed our system to respond more readily to the implemented changes. Understanding all of the relevant factors that lead to vaccination uptake can be applied to future hospital influenza vaccination campaigns. In addition, our work demonstrates that an interprofessional approach is still required to apply the functionality of the EMR effectively.

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Clinical Trial of Standing-Orders Strategies to Increase the Inpatient Influenza Vaccination Rate

Cited by 15 publications

References 7 publications

Improved Prophylaxis and Decreased Rates of Preventable Harm With the Use of a Mandatory Computerized Clinical Decision Support Tool for Prophylaxis for Venous Thromboembolism in Trauma

Improved Prophylaxis and Decreased Rates of Preventable Harm With the Use of a Mandatory Computerized Clinical Decision Support Tool for Prophylaxis for Venous Thromboembolism in Trauma

Effectiveness of non-interruptive nudge interventions in electronic health records to improve the delivery of care in hospitals: a systematic review

Influenza vaccination rates for hospitalised patients: a multiyear quality improvement effort

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