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Electronic clinical decision support to facilitate a change in clinical practice: Small details can make or break success. Transfusion 2020 Sep;60(9):1970-1976

Date

07/24/2020

Pubmed ID

32701187

DOI

10.1111/trf.15962

Scopus ID

2-s2.0-85088293974 (requires institutional sign-in at Scopus site)   4 Citations

Abstract

BACKGROUND: The use of electronic clinical decision support (CDS) is becoming common to change historically common clinical practices considered outdated by current guidelines. Preimplementation design of CDS tools is key to their success in changing clinical behaviors. Unfortunately, there are no established protocols for CDS tool development, and CDS failure can result from even small design flaws. This paper describes an example of a design oversight and how correction resulted in CDS success.

STUDY DESIGN AND METHODS: We performed a retrospective review of compliance with a CDS tool to encourage the use of prothrombin complex concentrate over plasma transfusion for the emergent reversal of warfarin. We identified a potential design flaw, made the necessary modifications, and repeated the compliance review.

RESULTS: After CDS, plasma orders declined by 150 units/mo; however, 48% of orders placed for non-warfarin coagulopathy were still for warfarin reversal. Hospital-wide, this noncompliance was 36% and was 80% in the emergency department. By simply relocating the qualifier "NOT on warfarin" from the end to the beginning of the order, noncompliance for warfarin reversal was reduced to 5% (P < .0001 by chi-square).

CONCLUSIONS: The successful use of electronic clinical decision support in the electronic medical record can depend on optimal design. Missing even small design elements such as the positioning of key terms within the tool can result in an ineffective CDS. Important design strategies to avoid poor performance are discussed as they relate to the CDS tool we describe.

Author List

Connor JP, Medow JE, Ehlenfeldt BD, Rose AE, Raife T

Author

Joshua E. Medow MD Professor in the Neurology department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Blood Coagulation Factors
Blood Component Transfusion
Decision Support Systems, Clinical
Humans
Plasma
Retrospective Studies
Warfarin