Patricia C Silveira1, Ivan K Ip2, Siobhan Sumption3, Ali S Raja4, Shahein Tajmir5, Ramin Khorasani6. 1. Center for Evidence Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: pcbsilveira@gmail.com. 2. Center for Evidence Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: iip@partners.org. 3. Center for Evidence Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: siobhansumption@gmail.com. 4. Center for Evidence Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: asraja@partners.org. 5. Center for Evidence Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: stajmir@partners.org. 6. Center for Evidence Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: rkhorasani@bwh.harvard.edu.
Abstract
OBJECTIVE: The objective of the study is to determine impact of a clinical decision support (CDS) tool on documented adherence to the Ottawa Ankle Rules (OAR) and utilization and yield of ankle/foot radiography, for emergency department patients with acute ankle injury. METHODS: This is a before-and-after intervention study conducted at a 793-bed, quaternary care, academic hospital from August 2012 to October 2013. Emergency department visits from adults with acute ankle injury 6 months before and 8 months after the intervention were included. The intervention embedded the OAR into a CDS tool integrated with a computerized physician order entry system, which had data capture capability and provided feedback at the time of ankle/foot radiography order. Primary outcome was rate of documented adherence to OAR. Secondary outcomes were utilization and yield (clinically significant fracture rates among patients with acute ankle injuries) of ankle/foot radiography. RESULTS: The study population included 460 visits; 205 (44.6%) occurred preintervention. After intervention, documented OAR adherence increased from 55.9% (229/410) to 95.7% (488/510; P < .001). Utilization remained stable for ankle (77.5%; P = .800) and foot (48.6%; P = .514) radiography. Yield remained stable for ankle (17.8%; P = .891) and foot (19.8%; P = .889) radiography. DISCUSSION: Lack of documentation of key clinical data may hamper provider communication, delay care coordination, and result in legal liability. By embedding the OAR into a CDS tool, we achieved the same rate of documented adherence as previous onerous educational implementations while automating data collection/retrieval. In summary, implementation of the OAR into a CDS tool was associated with an increase in documented adherence to the OAR.
OBJECTIVE: The objective of the study is to determine impact of a clinical decision support (CDS) tool on documented adherence to the Ottawa Ankle Rules (OAR) and utilization and yield of ankle/foot radiography, for emergency department patients with acute ankle injury. METHODS: This is a before-and-after intervention study conducted at a 793-bed, quaternary care, academic hospital from August 2012 to October 2013. Emergency department visits from adults with acute ankle injury 6 months before and 8 months after the intervention were included. The intervention embedded the OAR into a CDS tool integrated with a computerized physician order entry system, which had data capture capability and provided feedback at the time of ankle/foot radiography order. Primary outcome was rate of documented adherence to OAR. Secondary outcomes were utilization and yield (clinically significant fracture rates among patients with acute ankle injuries) of ankle/foot radiography. RESULTS: The study population included 460 visits; 205 (44.6%) occurred preintervention. After intervention, documented OAR adherence increased from 55.9% (229/410) to 95.7% (488/510; P < .001). Utilization remained stable for ankle (77.5%; P = .800) and foot (48.6%; P = .514) radiography. Yield remained stable for ankle (17.8%; P = .891) and foot (19.8%; P = .889) radiography. DISCUSSION: Lack of documentation of key clinical data may hamper provider communication, delay care coordination, and result in legal liability. By embedding the OAR into a CDS tool, we achieved the same rate of documented adherence as previous onerous educational implementations while automating data collection/retrieval. In summary, implementation of the OAR into a CDS tool was associated with an increase in documented adherence to the OAR.
Authors: Brian W Patterson; Michael S Pulia; Shashank Ravi; Peter L T Hoonakker; Ann Schoofs Hundt; Douglas Wiegmann; Emily J Wirkus; Stephen Johnson; Pascale Carayon Journal: Ann Emerg Med Date: 2019-01-03 Impact factor: 5.721
Authors: Wouter H Mallee; M M J Walenkamp; M A M Mulders; J C Goslings; N W L Schep Journal: Arch Orthop Trauma Surg Date: 2020-03-03 Impact factor: 3.067
Authors: Alisha P Chaudhry; Naveed Afzal; Mohamed M Abidian; Vishnu Priya Mallipeddi; Ravikumar K Elayavilli; Christopher G Scott; Iftikhar J Kullo; Paul W Wennberg; Joshua J Pankratz; Hongfang Liu; Rajeev Chaudhry; Adelaide M Arruda-Olson Journal: Mayo Clin Proc Innov Qual Outcomes Date: 2018-06
Authors: Marjolein A M Mulders; Monique M J Walenkamp; Nico L Sosef; Frank Ouwehand; Romuald van Velde; Carel J Goslings; Niels W L Schep Journal: Eur J Trauma Emerg Surg Date: 2019-09-20 Impact factor: 3.693