Impact of an Electronic Clinical Decision Support Tool for Emergency Department Patients With Pneumonia
Impact of an Electronic Clinical Decision Support Tool for Emergency Department Patients With Pneumonia
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DOI：
10.1016/j.annemergmed.2015.02.003
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发表时间：
2015-11-01
影响因子：
6.2
通讯作者：
Haug, Peter J.
中科院分区：
文献类型：
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作者：
Dean, Nathan C.;Jones, Barbara E.;Haug, Peter J.
研究目的：尽管有证据表明，遵守指南可以改善临床结局，但急诊科（ED）对肺炎患者的管理各不相同。我们研究了一个实时的，艾德，电子临床决策支持工具，为临床医生提供指南推荐的诊断，严重程度评估，处置，和抗生素selection.Methods的决策支持的效果：这是一个前瞻性的，对照的，准实验性试验在7间山区医疗保健医院的急诊科在犹他州的城市走廊。我们研究了2个时期内具有国际疾病分类第九版代码和肺炎影像学证据的成人：基线（2009年12月至2010年11月）和工具部署后（2011年12月至2012年11月）。该工具于2011年5月在4个干预ED部署，留下3个常规护理对照。我们比较了30天，全因死亡率调整疾病的严重程度，使用混合效应，逻辑回归model.Results：研究人群包括4,758艾德肺炎患者，14%的卫生保健相关性肺炎。中位年龄为58岁，53%为女性患者，59%入院。医生将该工具应用于62.6%的干预艾德研究患者。工具展开后，干预和常规护理ED之间的严重程度校正死亡率总体上没有差异（比值比[OR]=0.69; 95%置信区间[Cl] 0.41至1.16）。事后分析显示，社区获得性肺炎患者的死亡率显著降低（OR=0.53; 95%CI 0.28 - 0.99），而医疗保健相关性肺炎患者的死亡率无变化（OR=1.12; 95%CI 0.45 - 2.8）。从艾德postdeployment的患者处置坚持更多的工具recommendations.Conclusion：这项研究表明了实时电子临床决策支持艾德肺炎患者的可行性和潜在的好处。
Study objective: Despite evidence that guideline adherence improves clinical outcomes, management of pneumonia patients varies in emergency departments (EDs). We study the effect of a real-time, ED, electronic clinical decision support tool that provides clinicians with guideline-recommended decision support for diagnosis, severity assessment, disposition, and antibiotic selection.Methods: This was a prospective, controlled, quasi-experimental trial in 7 Intermountain Healthcare hospital EDs in Utah's urban corridor. We studied adults with International Classification of Diseases, Ninth Revision codes and radiographic evidence for pneumonia during 2 periods: baseline (December 2009 through November 2010) and post-tool deployment (December 2011 through November 2012). The tool was deployed at 4 intervention EDs in May 2011, leaving 3 as usual care controls. We compared 30-day, all-cause mortality adjusted for illness severity, using a mixed-effect, logistic regression model.Results: The study population comprised 4,758 ED pneumonia patients; 14% had health care-associated pneumonia. Median age was 58 years, 53% were female patients, and 59% were admitted to the hospital. Physicians applied the tool for 62.6% of intervention ED study patients. There was no difference overall in severity-adjusted mortality between intervention and usual care EDs post-tool deployment (odds ratio [OR]=0.69; 95% confidence interval [Cl] 0.41 to 1.16). Post hoc analysis showed that patients with community-acquired pneumonia experienced significantly lower mortality (OR=0.53; 95% Cl 0.28 to 0.99), whereas mortality was unchanged among patients with health care-associated pneumonia (OR=1.12; 95% Cl 0.45 to 2.8). Patient disposition from the ED postdeployment adhered more to tool recommendations.Conclusion: This study demonstrates the feasibility and potential benefit of real-time electronic clinical decision support for ED pneumonia patients.