Electronic Alerts for Triage Protocol Compliance Among Emergency Department Triage Nurses

Holmes, James F.; Freilich, Joshua D.; Taylor, Sandra L.; Buettner, David

doi:10.1097/nnr.0000000000000094

Cited by 7 publications

(7 citation statements)

References 20 publications

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“…Although this study was performed in a primary health care ED, these results are in line with former studies suggesting the usefulness of electronic reminders in altering clinical practice in all EDs [2][3][4][5][6][7]. Especially with the present, relatively simple type of intervention targeted at improving the quality of clinical recording, the application of electronic reminders seemed to function well.…”

Section: Discussionsupporting

confidence: 88%

The influence of electronic reminders on recording diagnoses in a primary health care emergency department: a register-based study in a Finnish town

Lehto

Pitkälä

Rahkonen

et al. 2021

Scandinavian Journal of Primary Health Care

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Objective: This study examines whether implementation of electronic reminders is associated with a change in the amount and content of diagnostic data recorded in primary health care emergency departments (ED). Design: A register-based 12-year follow-up study with a before-and-after design. Setting: This study was performed in a primary health care ED in Finland. An electronic reminder was installed in the health record system to remind physicians to include the diagnosis code of the visit to the health record. Subjects and main outcome measures: The report generator of the electronic health recordsystem provided monthly figures for the number of different recorded diagnoses by using the International Classification of Diagnoses (ICD-10th edition) and the total number of ED physician visits, thus allowing the calculation of the recording rate of diagnoses on a monthly basis and the comparison of diagnoses before and after implementing electronic reminders. Results: The most commonly recorded diagnoses in the ED were acute upper respiratory infections of various and unspecified sites (5.8%), abdominal and pelvic pain (4.8%), suppurative and unspecified otitis media (4.5%) and dorsalgia (4.0%). The diagnosis recording rate in the ED doubled from 41.2 to 86.3% (p < 0.001) after the application of electronic reminders. The intervention especially enhanced the recording rate of symptomatic diagnoses (ICD-10 group-R) and alcohol abuse-related diagnoses (ICD-10 code F10). Mental and behavioural disorders (group F) and injuries (groups S-Y) were also better recorded after this intervention. Conclusion: Electronic reminders may alter the documentation habits of physicians and recording of clinical data, such as diagnoses, in the EDs. This may be of use when planning resource managing in EDs and planning their actions. KEY POINTSElectronic reminders enhance recording of diagnoses in primary care but what happens in emergency departments (EDs) is not known. Electronic reminders enhance recording of diagnoses in primary care ED. Especially recording of symptomatic diagnoses and alcohol abuse-related diagnoses increased.

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Section: Discussionsupporting

confidence: 88%

The influence of electronic reminders on recording diagnoses in a primary health care emergency department: a register-based study in a Finnish town

Lehto

Pitkälä

Rahkonen

et al. 2021

Scandinavian Journal of Primary Health Care

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“…Additionally, there is a risk that participants in the intervention groups may discuss the information provided by the CCDSS with participants in the control group, resulting in performance bias. That the inability to properly blind the participants and the Hawthorne effect may have a significant effect on results was painfully demonstrated in the study by Holmes et al 22 wherein a single nurse was responsible for a significant improvement in guideline implementation for the whole control group and subsequently cancelled a difference in effect with the intervention group. To correctly observe a true effect of CCDSSs, it remains imperative that researchers set up sound research designs taking into account the complexity of CCDSSs in order to minimize any risk of bias.…”

Section: Strengths and Limitations Of This Reviewmentioning

confidence: 99%

“…46,47 Thirteen studies (57%) evaluated CCDSSs in primary care,* 5 (22%) in hospital outpatient ambulatory care, 26,31,33,36,44 and 5 (22%) in hospital inpatient care. 22,25,32,34 Intervention.-Fifteen different CCDSSs were studied, of which 6 (40%) were focused solely on laboratory testing, † 5 (33%) also included other reminders such as treatment options, [27][28][29]31,39,[41][42][43] and 4 (27%) were not stand-alone systems, but were developed by an EHR software vendor. ‡ Of the CCDSSs focused solely on laboratory testing, 3 (50%) were targeted at regulating blood clotting in patients using anticoagulants.…”

Section: Included Studiesmentioning

confidence: 99%

“…Almost all studies could not sufficiently blind the health care providers to the intervention. Four studies (17%) attempted to blind the participants by introducing a CCDSS in both the intervention and the control group, but aimed at a different pathology [20][21][22] or with a different design. 23, 24 Trials with randomization on the patient level could not guarantee the absence of performance bias because health care providers were not fully blinded to the intervention and cared for patients in both the intervention and control groups.…”

Section: Included Studiesmentioning

confidence: 99%

“…[20][21][22][24][25][26][27][28][29][30][31][32][33][34][35][36][37] Eight studies (35%) were conducted in Europe. 23,[38][39][40][41][42][43][44][45] One study (4%) was conducted in Europe and Australia.…”

Section: Included Studiesmentioning

confidence: 99%

See 2 more Smart Citations

The Effects of Computerized Clinical Decision Support Systems on Laboratory Test Ordering: A Systematic Review

Delvaux¹,

Thienen²,

Heselmans³

et al. 2017

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Inappropriate laboratory test ordering has been shown to be as high as 30%. This can have an important impact on quality of care and costs because of downstream consequences such as additional diagnostics, repeat testing, imaging, prescriptions, surgeries, or hospital stays.Objective.-To evaluate the effect of computerized clinical decision support systems on appropriateness of laboratory test ordering.Data Sources.-We used MEDLINE, Embase, CINAHL, MEDLINE In-Process and Other Non-Indexed Citations, Clinicaltrials.gov, Cochrane Library, and Inspec through December 2015. Investigators independently screened articles to identify randomized trials that assessed a computerized clinical decision support system aimed at improving laboratory test ordering by providing patientspecific information, delivered in the form of an on-screen management option, reminder, or suggestion through a computerized physician order entry using a rule-based or algorithm-based system relying on an evidence-based knowledge resource. Investigators extracted data from 30 papers about study design, various study characteristics, study setting, various intervention characteristics, involvement of the software developers in the evaluation of the computerized clinical decision support system, outcome types, and various outcome characteristics.Conclusions.-Because of heterogeneity of systems and settings, pooled estimates of effect could not be made. Data showed that computerized clinical decision support systems had little or no effect on clinical outcomes but some effect on compliance. Computerized clinical decision support systems targeted at laboratory test ordering for multiple conditions appear to be more effective than those targeted at a single condition.(Arch Pathol Lab Med. 2017;141:585-595; doi: 10.5858/ arpa.2016-0115-RA) A fter years of persistent increase, laboratory test ordering has become the highest-volume medical act. In the United States 1 and Europe, 55 the annual increase in the use of laboratory tests averaged around 5% during the last decade. Medicare 2 spending for clinical laboratory testing has peaked at almost $10 billion, accounting for 1.7% of the total health care budget. However, it has been estimated that when including non-Medicare spending, the figures for the United States are up to 7 times higher.3 In Europe, laboratory spending accounted for 1.8% of total health care spending in 2012, totaling E17 billion. Overuse of laboratory test ordering has been shown to be at 20%. 4 Even though reducing the overuse of laboratory testing may not seem very important in relation to the whole of health care spending, the true benefits are to be found in reducing downstream costs.5 These downstream activities include additional diagnostics such as repeat testing or imaging, prescriptions, surgeries, and hospital stays. Besides reducing costs, improving appropriate laboratory test ordering improves the quality of care by avoiding false-positive results and accidental findings of unknown significance, 6 and is not ass...

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The effects of on-screen, point of care computer reminders on processes and outcomes of care

Shojania

Jennings²,

Mayhew

et al. 2009

Cochrane Database of Systematic Reviews

363

339

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Background The opportunity to improve care by delivering decision support to clinicians at the point of care represents one of the main incentives for implementing sophisticated clinical information systems. Previous reviews of computer reminder and decision support systems have reported mixed effects, possibly because they did not distinguish point of care computer reminders from e-mail alerts, computer-generated paper reminders, and other modes of delivering ‘computer reminders’. Objectives To evaluate the effects on processes and outcomes of care attributable to on-screen computer reminders delivered to clinicians at the point of care. Search methods We searched the Cochrane EPOC Group Trials register, MEDLINE, EMBASE and CINAHL and CENTRAL to July 2008, and scanned bibliographies from key articles. Selection criteria Studies of a reminder delivered via a computer system routinely used by clinicians, with a randomised or quasi-randomised design and reporting at least one outcome involving a clinical endpoint or adherence to a recommended process of care. Data collection and analysis Two authors independently screened studies for eligibility and abstracted data. For each study, we calculated the median improvement in adherence to target processes of care and also identified the outcome with the largest such improvement. We then calculated the median absolute improvement in process adherence across all studies using both the median outcome from each study and the best outcome. Main results Twenty-eight studies (reporting a total of thirty-two comparisons) were included. Computer reminders achieved a median improvement in process adherence of 4.2% (interquartile range (IQR): 0.8% to 18.8%) across all reported process outcomes, 3.3% (IQR: 0.5% to 10.6%) for medication ordering, 3.8% (IQR: 0.5% to 6.6%) for vaccinations, and 3.8% (IQR: 0.4% to 16.3%) for test ordering. In a sensitivity analysis using the best outcome from each study, the median improvement was 5.6% (IQR: 2.0% to 19.2%) across all process measures and 6.2% (IQR: 3.0% to 28.0%) across measures of medication ordering. In the eight comparisons that reported dichotomous clinical endpoints, intervention patients experienced a median absolute improvement of 2.5% (IQR: 1.3% to 4.2%). Blood pressure was the most commonly reported clinical endpoint, with intervention patients experiencing a median reduction in their systolic blood pressure of 1.0 mmHg (IQR: 2.3 mmHg reduction to 2.0 mmHg increase). Authors’ conclusions Point of care computer reminders generally achieve small to modest improvements in provider behaviour. A minority of interventions showed larger effects, but no specific reminder or contextual features were significantly associated with effect magnitude. Further research must identify design features and contextual factors consistently associated with larger improvements in provider behaviour if computer reminders are to succeed on more than a trial and error basis.

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Electronic Alerts for Triage Protocol Compliance Among Emergency Department Triage Nurses

Cited by 7 publications

References 20 publications

The influence of electronic reminders on recording diagnoses in a primary health care emergency department: a register-based study in a Finnish town

The influence of electronic reminders on recording diagnoses in a primary health care emergency department: a register-based study in a Finnish town

The Effects of Computerized Clinical Decision Support Systems on Laboratory Test Ordering: A Systematic Review

The effects of on-screen, point of care computer reminders on processes and outcomes of care

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