The effect of defaults in an electronic health record on laboratory test ordering practices for pediatric patients.

Probst, C. Adam; Shaffer, Victoria A.; Chan, Yi‐Hsin

doi:10.1037/a0032925

Cited by 35 publications

(23 citation statements)

References 39 publications

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“…As illustrated in the case of organ donation, Johnson and Goldstein (2003) found evidence that the propensity to be an organ donor was nearly twice as high, when organ donation was the SQ alternative compared to when the SQ alternative was no organ donation. Similar examples are found in Probst et al (2013) in relation to the ordering of laboratory test practices for paediatric patients and Chapman et al (2010) in relation to influenza vaccination. In all the mentioned cases, the SQ alternative acts as a threshold, which the gain/benefit of a choice away from the SQ situation must exceed, in order for the individual to make that choice.…”

Section: Introductionmentioning

confidence: 52%

Reducing Status Quo Bias in Choice Experiments

Bonnichsen

Ladenburg²

2015

Nordic J Health Eco

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To secure the validity and applicability of stated preference measures in economic analysis, hypothetical preferences must mimic real life preferences. For instance, people have a propensity to prefer what they already have when presented with alternatives that, all things being equal, seem to be superior, i.e. a status quo effect. However, in the stated preference literature, the tendency to choose the alternative representing the status quo situation seems to exceed real life status quo effects. Accordingly, status quo bias can be a problem. In the Choice Experiment literature, status quo bias is found to be a function of protest attitudes concerning the payment of the hypothetical good. In a split sample framework we test an ex-ante entreaty aimed at reducing payment based protest attitudes. We find that the entreaty reduces status quo bias and improves the internal validity of stated preferences in our data based on Swedish ostomates’ preferences for ostomy pouch quality changes. Published: Online January 2015. In print December 2015.

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Section: Introductionmentioning

confidence: 52%

Reducing Status Quo Bias in Choice Experiments

Bonnichsen

Ladenburg²

2015

Nordic J Health Eco

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“…Factors contributing to the success of the QI intervention include collaboration among a multidisciplinary team (including hospitalists, nursing leadership, nurse educators, and bedside nurse champions), point-of-care reminders of pathway metrics and protocols visible at the bedside, and EMR order sets, which are associated with decreased variation in ordering practices. 15,16 Use of bedside nurse champions and repeated bedside discussions on rounds helped in adoption of the change. Despite the above measures, a barrier to early adoption was encountered in cycle 1, in which many physicians were hesitant to omit CPO, and the nursing staff placed patients on continuous monitors despite orders for IPO, likely reflecting the historical practice of close monitoring.…”

Section: Discussionmentioning

confidence: 99%

“…Default preselections in an EHR order set have been shown to influence ordering practices. 16 There are several limitations that must be recognized. Our average LOS of 33 hours (1.37 days) during cycle 2 was much shorter than the LOS of 2.2 to 3.3 days reported in previous studies.…”

Section: Discussionmentioning

confidence: 99%

Successful Use of Quality Improvement Methodology to Reduce Inpatient Length of Stay in Bronchiolitis Through Judicious Use of Intermittent Pulse Oximetry

Mittal

Marlowe

Blakeslee

et al. 2019

Hospital Pediatrics

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BACKGROUND AND OBJECTIVES: The American Academy of Pediatrics 2014 bronchiolitis guidelines recommend against the routine use of continuous pulse oximetry (CPO) because it has been implicated in prolonging the length of stay (LOS). At our institution, infants admitted with bronchiolitis were monitored by using CPO during the entire hospital stay and intermittent desaturations ,90% appeared to delay discharge. This quality improvement initiative was designed to reduce the LOS by decreasing the use of CPO in stable infants with nonsevere bronchiolitis. METHODS: The quality improvement project was implemented on the inpatient units of 2 community hospitals during the 2016 and 2017 bronchiolitis seasons. In cycle 1 (January 2016 to April 2016), the bronchiolitis pathway from the associated quaternary children's hospital was used to (1) limit the use of CPO to patients with severe bronchiolitis and those at high risk for apnea or severe disease, (2) discontinue CPO as patients improved and stabilized, and (3) standardize discharge criteria. In cycle 2 (November 2016 to April 2017), the clinical pathway was adopted. The main outcome measure was LOS, measured from the time of the admission order to the time of the discharge order. Process measures included compliance with the interventions. RESULTS: The project included 373 patients, 180 preintervention and 193 postintervention. The average LOS decreased by 20 hours, from 53 hours at baseline to 33 hours in cycle 2. No adverse events were noted, and there was no significant change in the number of emergency department revisits and readmissions within 7 days. CONCLUSIONS: In our study, LOS was successfully reduced in bronchiolitis patients by using a clinical pathway that limited CPO to patients with severe bronchiolitis and those at risk for severe disease or apnea.

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“…The effect of defaults in an electronic health record environment has been shown to significantly influence clinicians’ ordering habits. 26 …”

Section: Discussionmentioning

confidence: 99%

Premedication Use Before Infliximab Administration

Picoraro

Winberry

Siegel

et al. 2017

Inflammatory Bowel Diseases

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Background Premedications are commonly given to inflammatory bowel disease (IBD) patients prior to intravenous infliximab administration. We aimed to (1) describe practice variability; and (2) determine clinician rationale for premedicating IBD patients prior to infliximab administration. Methods We developed a cross-sectional electronic survey after comprehensive literature review to assess practice variability and clinician rationale for premedication use prior to infliximab. An optional post-survey quiz assessed clinicians’ understanding of available literature. The survey was distributed through members-only NASPGHAN and Crohn’s and Colitis Foundation of America (CCFA) listservs and American Gastroenterological Association (AGA) and American College of Gastroenterology (ACG) web-based discussion boards. Results 379 unique respondents with a 93.3% survey completion rate comprised 331 (87%) and 45 (12%) pediatric and adult gastroenterologists. Among numerous options for premedications, acetaminophen (66%) and diphenhydramine (64%) were most often given prior to each infliximab infusion. Only 20% did not routinely use premedications. There was heterogeneity of premedication use between gastroenterologists within the same clinical practice. Of 328 (87%) respondents who completed the knowledge assessment quiz, only 18% identified the association of diphenhydramine use with increased reaction. Conclusion There is high inter- and intra-practice variability for premedication use prior to infliximab administration. Clinician rationale for premedicating patients appears to be driven by individual preference or group practice habit. Improved knowledge of the evidence may assist in decreasing over-use of premedications, particularly diphenhydramine.

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The effect of defaults in an electronic health record on laboratory test ordering practices for pediatric patients.

Abstract: This study demonstrated that default selections in an EHR can significantly influence providers' laboratory test ordering practices and that hospital systems could benefit from adding expert-recommended defaults to EHR order sets.

Cited by 35 publications

References 39 publications

Reducing Status Quo Bias in Choice Experiments

Reducing Status Quo Bias in Choice Experiments

Successful Use of Quality Improvement Methodology to Reduce Inpatient Length of Stay in Bronchiolitis Through Judicious Use of Intermittent Pulse Oximetry

Premedication Use Before Infliximab Administration

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