A framework for evaluating the appropriateness of clinical decision support alerts and responses
This is a review of McCoy, Waitman, Lewis, Wright, Choma, Miller and Peterson’s 2012 article, A framework for evaluating the appropriateness of clinical decision support alerts and responses.[1]
Contents
Introduction
With healthcare transitioning into the 21st century, more and more hospitals and clinics are making the switch from paper-based records to Electronic Health Records (EMR). Included in the EMRs are Computerized Provider Order Entries (CPOE) and Clinical Decision Support (CDS). These two features are aimed to specifically improve patient safety. Clinical Decision Support is a process for enhancing health-related decisions and actions with pertinent, organized clinical knowledge and patient information to improve health and healthcare delivery. [2]
The authors present a comprehensive framework for evaluating the clinical appropriateness of synchronous, interruptive medication safety alerts. [1]
Methods
Through literature review and iterative testing, metrics were developed that describe successes, justifiable overrides, provider non-adherence, and unintended adverse consequences of clinical decision support alerts.[1]
The framework was validated by applying it to a medication alerting system for patients with acute kidney injury (AKI).[1] The site location for this validation was at Vanderbilt University Hospital. The author’s evaluated the AKI alerts by comparing it to their framework retrospectively.
Results
A total of 487 alerts were evaluated by the reviewers. After a group consensus was made, the authors decided to select 391 alerts to display.
Contributing factors to alert display inappropriateness included:[1]
- No AKI actually present because of laboratory error
- Medications or conditions interfering with creatinine assays
- Insufficient change in glomerular filtration rate for 54% of inappropriate alerts
Additional contributing factors to alert display inappropriateness included:[1]
- The pre-alert medication dose was acceptable because of a previous adjustment
- Drug doses not subject to adjustment because of short-duration prophylaxis
- Presence of clinician monitoring of therapeutic drug levels for 33% of inappropriate alerts.
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 McCoy, A. B., Waitman, L. R., Lewis, J. B., Wright, J. A., Choma, D. P., Miller, R. A., & Peterson, J. F. (2012). A framework for evaluating the appropriateness of clinical decision support alerts and responses. Journal of the American Medical Informatics Association : JAMIA, 19(3), 346–352. doi:10.1136/amiajnl-2011-000185
- ↑ http://www.himss.org/library/clinical-decision-support
