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

Reingold, Stewart; Kulstad, Erik

doi:10.1111/j.1553-2712.2007.tb02395.x

Cited by 12 publications

(4 citation statements)

References 5 publications

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“…Olson et al reported that pre-selecting a post-transfusion hematocrit order within a red cell transfusion order set increased frequency of testing from 8.3% to 57.4% after transfusion (10). Similar findings were observed for CPOE use in managing congestive heart failure (11), analgesic treatment for renal colic (12), and sepsis (13). According to the Medicare Clinical Laboratory Fee Schedule, our intervention resulted in savings of $5,955 during the study period ($10,455in the pre-period vs. $4,500 in the post intervention, at national median Medicare payment rate of $15.00 per urine culture)(14).…”

Section: Discussionsupporting

confidence: 65%

Impact of order set design on urine culturing practices at an academic medical centre emergency department

et al. 2018

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A simple intervention of retaining only 'urinalysis with reflex to microscopy' and removing all other urine tests from the 'frequently ordered' window of the ED electronic order set decreased urine cultures ordered by 46.6% after accounting for temporal trends. Given the injudicious use of antimicrobial therapy for asymptomatic bacteriuria, findings from our study suggest that proper design of electronic order sets plays a vital role in reducing excessive ordering of urine cultures.

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Section: Discussionsupporting

confidence: 65%

Impact of order set design on urine culturing practices at an academic medical centre emergency department

et al. 2018

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“…Adoption of the BHCS heart failure order set is comparable to that reported for order sets implemented in the Grey Bruce Health Network in Canada ( 40% systemwide after 6 months) [22] and mirrored the 72% adoption of an emergency department heart failure clinical pathway 14 months postimplementation at a single suburban tertiary care hospital [23]. Similarly, previous studies have shown similar improvements in heart failure outcomes following implementation of hospital-based tools to increase standardization.…”

Section: Comparison To the Literaturesupporting

confidence: 65%

Impact of a standardized heart failure order set on mortality, readmission, and quality and costs of care

Ballard

Ogola

Fleming

et al. 2010

International Journal for Quality in Health Care

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“…Multiple studies evaluating the use of standardized care bundles in the management of heart failure exacerbations were able to show reduced 30-day mortality and 30-day readmission rates. 26 – 28 Meanwhile, evidence-based care bundles have been used in the management of sepsis and septic shock with results significant for earlier administration of antibiotics, improved 30-day mortality, less utilization of vasopressors, and decreased length of stay. 29 – 31 Studies that examined care bundle use for surgical admissions have also proven to reduce length of stay and hospital costs.…”

Section: Introductionmentioning

confidence: 99%

COPD exacerbation care bundle improves standard of care, length of stay, and readmission rates

Parikh¹,

Shah²,

Tandon³

2016

COPD

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IntroductionCOPD is the third leading cause of death in the world. Utilizing care bundles during acute COPD exacerbations results in fewer complications and lower costs. Our aim was to construct a COPD exacerbation care bundle and evaluate the effects on patient care.MethodsWe conducted a prospective analysis of 44 patients admitted with a COPD exacerbation to a single tertiary care facility. Primary outcomes included length of stay, readmission rates, and hospital costs. Secondary outcomes included patient education, pulmonologist follow-up, and timeliness of medication administration. Two cohorts were analyzed: those treated with an electronic COPD care bundle (cases; N=22) versus those treated without the care bundle (controls; N=22).ResultsMean length of stay (51.2 vs 101.1 hours in controls; P-value =0.001), 30-day readmission rates (9.1% vs 54.4% in controls; P-value =0.001), and 60-day readmission rates (22.7% vs 77% in controls; P-value =0.0003) decreased in the care bundle group. Ninety-day hospital costs had a significant difference in the care bundle group (US$7,652 vs US$19,954 in controls; P-value =0.044). Secondary outcomes included a 100% rate of COPD inhaler teaching (vs 27.3% in controls; P-value <0.001), 59.1% rate of pulmonologist follow-up after discharge (vs 18.2% in controls; P-value =0.005), and a mean reduction in time to steroid administration (7.0 hours; P-value =0.015) seen in the care bundle cases.ConclusionOur significant findings coupled with the recent success of standardized algorithms in managing COPD exacerbations stress the importance of enforcing clinical guidelines that can enhance patient care. We demonstrated improved care for COPD exacerbation patients during hospitalizations, thereby decreasing morbidity and the financial burden hospitals face in regard to this increasingly prevalent disease.

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

Abstract: Background: Although standardized physician order sets are often part of quality improvement projects, the specific design elements contributing to increased adoption and compliance with use often are not considered.

Cited by 12 publications

References 5 publications

Impact of order set design on urine culturing practices at an academic medical centre emergency department

Impact of order set design on urine culturing practices at an academic medical centre emergency department

Impact of a standardized heart failure order set on mortality, readmission, and quality and costs of care

COPD exacerbation care bundle improves standard of care, length of stay, and readmission rates

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