Heterogeneous effect of an emergency department expert charting system

Buller-Close, Kelly; Schriger, David L.; Baraff, Larry J.

doi:10.1067/mem.2003.182

Cited by 32 publications

(19 citation statements)

References 34 publications

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“…In recognition of the importance of clinical documentation, recording electronic notes in patient charts is included as one of the menu objectives in Stage-2 of the Meaningful Use Program (11). Also, the lack of standardization in EHR clinical documentation and display styles provides interface designers with an area of opportunity to re-design EHR systems (12–15). …”

Section: Introductionmentioning

confidence: 99%

A comparative observational study of inpatient clinical note-entry and reading/retrieval styles adopted by physicians

Rizvi

Harder

Hultman

et al. 2016

International Journal of Medical Informatics

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Objective The objective of this study is to understand physicians’ usage of inpatient notes by (i) ascertaining different clinical note-entry and reading/retrieval styles in two different and widely used Electronic Health Record (EHR) systems, (ii) extrapolating potential factors leading to adoption of various note-entry and reading/retrieval styles and (iii) determining the amount of time to task associated with documenting different types of clinical notes. Methods In order to answer “what” and “why” questions on physicians’ adoption of certain note-entry and reading/retrieval styles, an ethnographic study entailing Internal Medicine residents, with a mixed data analysis approach was performed. Participants were observed interacting with two different EHR systems in inpatient settings. Data was collected around the use and creation of History and Physical (H&P) notes, progress notes and discharge summaries. Results The highest variability in template styles was observed with progress notes and the least variability was within discharge summaries, while note-writing styles were most consistent for H&P notes. The first section to be read in a H&P and progress note were the Chief Complaint and Assessment & Plan sections, respectively. The greatest note retrieval variability, with respect to the order of how note sections were reviewed, was observed with H&P and progress notes. Physician preference for adopting a certain reading/retrieval order appeared to be a function of what best fits their workflow while fulfilling the stimulus demands. The time spent entering H&P, discharge summaries and progress notes were similar in both EHRs. Conclusion This research study unveils existing variability in clinical documentation processes and provides us with important information that could help in designing a next generation EHR Graphical User Interface (GUI) that is more congruent with physicians’ mental models, task performance needs, and workflow requirements.

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Section: Introductionmentioning

confidence: 99%

A comparative observational study of inpatient clinical note-entry and reading/retrieval styles adopted by physicians

Rizvi

Harder

Hultman

et al. 2016

International Journal of Medical Informatics

View full text Add to dashboard Cite

show abstract

“…33 In the ED, Schriger et al and other investigators have used CDSS by using a more limited approach with a rule-based computer charting system that allows orders based on entered data. [18][19][20] Compliance with this effort has been best with more limited problems, such as body fluid exposure, than with more complex problems, such as pediatric fever or back pain.…”

Section: Discussionmentioning

confidence: 99%

“…[11][12][13] Exclusive evaluation of written standing orders within the emergency department (ED) has been limited to use of preprinted order sheets that successfully improved management of septic shock 7 and reduced pediatric medication errors. 14 Numerous studies have examined computerized physician order entry (CPOE) and clinical decision support systems (CDSS) in emergency medicine [15][16][17][18][19][20] and other areas of medicine, 4,21 with mixed results. Although implementation of CPOE is a national high priority, 22 widespread use has been limited.…”

mentioning

confidence: 99%

Impact of Human Factor Design on the Use of Order Sets in the Treatment of Congestive Heart Failure

Reingold¹,

Kulstad²

2007

Academic Emergency Medicine

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“…To encourage appropriate use of the enzyme-linked immunosorbent assay (ELISA) D-dimer as outlined in the guideline, the summary (Table 1) was embedded in the software of the electronic medical record and showed as a ''pop-up'' on the order entry screen whenever a physician ordered a D-dimer test. 9,18 Physicians were also encouraged to utilize a simple worksheet that included a summary flow diagram and the following questions: 1) Does the patient typically seek care at Spectrum Health? 2) What is the pretest probability for PE: low (,20%) The study population consisted of a consecutive sample of adult patients (18 years or older) presenting to the ED with clinical suspicion of acute PE.…”

Section: Methodsmentioning

confidence: 99%

“…[1][2][3][4][5][6][7] Clinical guidelines or protocols may assist physicians with complicated diagnostic algorithms and improve care by decreasing inappropriate variance in practice style. 8,9 At the same time, algorithms that reduce patient care into a sequence of binary decisions often do injustice to the complexity of medicine. 10 The rationale for a PE ruleout protocol has been described; however, the safety and efficiency of a PE rule-out protocol awaits empiric confirmation.…”

Section: Introductionmentioning

confidence: 99%

An Emergency Department Guideline for the Diagnosis of Pulmonary Embolism: An Outcome Study

Brown¹,

Vance²,

Kline³

2005

Acad Emergency Med

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Objective: To assess the clinical outcome of patients suspected of pulmonary embolism (PE) following implementation of an emergency department (ED) diagnostic guideline. Methods: A prospective observational study of all patients suspected of PE who presented to the ED during a four-month study period. The authors' modification of the Charlotte criteria recommended D-dimer testing in those younger than 70 years of age with a low clinical suspicion of PE and no unexplained hypoxemia, unilateral leg swelling, recent surgery, hemoptysis, pregnancy, or prolonged duration of symptoms. The primary outcome was the identification of venous thromboembolism during a three-month follow-up period. The negative predictive value of the overall diagnostic strategy and the test characteristics of D-dimer were calculated. Results: A total of 1,207 consecutive patients were evaluated for suspected PE; 71 (5.8%) were diagnosed with venous thromboembolism. One missed case of PE was identified on follow-up, yielding a negative predictive value of 99.9% (95% confidence interval [CI] = 99.5% to 100%). The missed case was a patient who presented with pleuritic chest pain and shortness of breath; a chest radiograph revealed pneumothorax, and the physician decided not to pursue the positive D-dimer result. The patient returned six weeks later with PE. Subgroup analysis of patients having D-dimer performed (n = 677) yields a sensitivity of 0.93 (95% CI = 0.77 to 0.98) and a specificity of 0.74 (95% CI = 0.70 to 0.77). Conclusions: Implementation of a PE diagnostic guideline in a community ED setting is safe and has improved the specificity of the enzyme-linked immunosorbent assay D-dimer test when compared with previous studies. Key words: pulmonary embolism; diagnosis; guideline. ACADEMIC EMERGENCY MEDICINE 2005; 12:20-25. The evaluation of patients suspected of pulmonary embolism (PE) is complex, and numerous diagnostic strategies have been suggested. [1][2][3][4][5][6][7] Clinical guidelines or protocols may assist physicians with complicated diagnostic algorithms and improve care by decreasing inappropriate variance in practice style. 8,9 At the same time, algorithms that reduce patient care into a sequence of binary decisions often do injustice to the complexity of medicine. 10 The rationale for a PE ruleout protocol has been described; however, the safety and efficiency of a PE rule-out protocol awaits empiric confirmation. 11,12Generally, simple innovations spread faster than complicated ones. 13 A prediction rule will be used if it makes clinical sense and is simple.14 One of the aims of our PE diagnostic guideline was to simplify the complicated algorithms and decision rules that have been proposed. 1 The guideline focus was on pretest probability assessment and the appropriate use of D-dimer testing. 7,8,12 The implementation of a PE ruleout protocol or guideline requires the understanding and approval of physicians at the local level. The emergency physicians at our institution agreed to start with empiric clinical ju...

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Heterogeneous effect of an emergency department expert charting system

Cited by 32 publications

References 34 publications

A comparative observational study of inpatient clinical note-entry and reading/retrieval styles adopted by physicians

A comparative observational study of inpatient clinical note-entry and reading/retrieval styles adopted by physicians

Impact of Human Factor Design on the Use of Order Sets in the Treatment of Congestive Heart Failure

An Emergency Department Guideline for the Diagnosis of Pulmonary Embolism: An Outcome Study

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