Implementation of an Electronic Clinical Decision Support Tool for Pediatric Appendicitis Within a Hospital Network

Marissa A. Hendrickson; Andrew R. Wey; Philippe R. Gaillard; Anupam B. Kharbanda

doi:10.1097/PEC.0000000000001069

Implementation of an Electronic Clinical Decision Support Tool for Pediatric Appendicitis Within a Hospital Network

Marissa A. Hendrickson, Andrew R. Wey, Philippe R. Gaillard, Anupam B. Kharbanda

Research output: Contribution to journal › Article › peer-review

16 Scopus citations

Abstract

Objectives Computed tomography (CT) has been widely used in the evaluation of children with suspected appendicitis, but concerns about ionizing radiation have increased interest in ultrasound for these patients. We sought to assess the effectiveness of an appendicitis electronic clinical decision support (E-CDS) system in increasing ultrasound and decreasing CT use in children evaluated in emergency departments (EDs) for suspected appendicitis. Methods This was a preintervention and postintervention analysis of an E-CDS implemented into an electronic health record system shared by an academic, tertiary-care children's hospital and a community hospital. The tool consisted of a structured order set with embedded clinical advice and a link to a Web site. Emergency department patients aged 3 to 18 years with suspected appendicitis were reviewed retrospectively. Imaging use was assessed 3 months before and 6 months after implementation of the intervention. Results Three hundred twenty-seven patients were identified, 211 at postintervention; 80% were seen in the community ED. Among community ED patients with imaging, ultrasound use increased (36%-51%, P = 0.049), and CT scan use decreased (81%-66%, P = 0.044) in the postintervention period, with no change in complications or safety outcomes. No difference was found in ultrasound rate (100%-97%, P = 1.000) or CT scan rate (13%-10%, P = 1.000) among children's ED patients with imaging. Conclusions An E-CDS can effectively decrease CT scanning and increase use of ultrasound in children with suspected appendicitis in a community hospital ED. Electronic clinical decision support may be an effective method of disseminating pediatric best practices from a children's hospital to affiliated community EDs.

Original language	English (US)
Pages (from-to)	10-16
Number of pages	7
Journal	Pediatric Emergency Care
Volume	34
Issue number	1
DOIs	https://doi.org/10.1097/PEC.0000000000001069
State	Published - Jan 1 2018

Bibliographical note

Funding Information:
From the *Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Minnesota Medical School and University of Minnesota Masonic Children’s Hospital, Minneapolis, MN; †Biostatistics and Data Management Core, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI; ‡Department of Mathematics and Statistics, Auburn University, Auburn, AL; §Department of Pediatric Emergency Medicine, Children’s Hospitals and Clinics of Minnesota, Minneapolis, MN. This investigation was partially funded by a grant from the ABIM Foundation, Putting the Charter Into Practice grant 242. Additional support was provided by National Institutes of Health grants UL1TR000114, U54MD007584, and G12MD007601. Disclosure: The authors declare no conflict of interest. Reprints: Marissa A. Hendrickson, MD, Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Minnesota Medical School and University of Minnesota Masonic Children’s Hospital, M653 E Bldg, 2450 Riverside Ave S, Minneapolis, MN 55454 (e‐mail: [email protected]). Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0749-5161

Publisher Copyright:
© Wolters Kluwer Health, Inc. All rights reserved.

Keywords

appendicitis
clinical decision support
community hospital
ultrasound

Publisher link

10.1097/PEC.0000000000001069

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5591754

Find It

Find It at U of M Libraries

Cite this

@article{84b08f4af9e5434eb7d09157b09e0719,

title = "Implementation of an Electronic Clinical Decision Support Tool for Pediatric Appendicitis Within a Hospital Network",

abstract = "Objectives Computed tomography (CT) has been widely used in the evaluation of children with suspected appendicitis, but concerns about ionizing radiation have increased interest in ultrasound for these patients. We sought to assess the effectiveness of an appendicitis electronic clinical decision support (E-CDS) system in increasing ultrasound and decreasing CT use in children evaluated in emergency departments (EDs) for suspected appendicitis. Methods This was a preintervention and postintervention analysis of an E-CDS implemented into an electronic health record system shared by an academic, tertiary-care children's hospital and a community hospital. The tool consisted of a structured order set with embedded clinical advice and a link to a Web site. Emergency department patients aged 3 to 18 years with suspected appendicitis were reviewed retrospectively. Imaging use was assessed 3 months before and 6 months after implementation of the intervention. Results Three hundred twenty-seven patients were identified, 211 at postintervention; 80% were seen in the community ED. Among community ED patients with imaging, ultrasound use increased (36%-51%, P = 0.049), and CT scan use decreased (81%-66%, P = 0.044) in the postintervention period, with no change in complications or safety outcomes. No difference was found in ultrasound rate (100%-97%, P = 1.000) or CT scan rate (13%-10%, P = 1.000) among children's ED patients with imaging. Conclusions An E-CDS can effectively decrease CT scanning and increase use of ultrasound in children with suspected appendicitis in a community hospital ED. Electronic clinical decision support may be an effective method of disseminating pediatric best practices from a children's hospital to affiliated community EDs.",

keywords = "appendicitis, clinical decision support, community hospital, ultrasound",

author = "Hendrickson, {Marissa A.} and Wey, {Andrew R.} and Gaillard, {Philippe R.} and Kharbanda, {Anupam B.}",

note = "Funding Information: From the *Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Minnesota Medical School and University of Minnesota Masonic Children{\textquoteright}s Hospital, Minneapolis, MN; †Biostatistics and Data Management Core, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI; ‡Department of Mathematics and Statistics, Auburn University, Auburn, AL; §Department of Pediatric Emergency Medicine, Children{\textquoteright}s Hospitals and Clinics of Minnesota, Minneapolis, MN. This investigation was partially funded by a grant from the ABIM Foundation, Putting the Charter Into Practice grant 242. Additional support was provided by National Institutes of Health grants UL1TR000114, U54MD007584, and G12MD007601. Disclosure: The authors declare no conflict of interest. Reprints: Marissa A. Hendrickson, MD, Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Minnesota Medical School and University of Minnesota Masonic Children{\textquoteright}s Hospital, M653 E Bldg, 2450 Riverside Ave S, Minneapolis, MN 55454 (e‐mail: [email protected]). Copyright {\textcopyright} 2017 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0749-5161 Publisher Copyright: {\textcopyright} Wolters Kluwer Health, Inc. All rights reserved.",

year = "2018",

month = jan,

day = "1",

doi = "10.1097/PEC.0000000000001069",

language = "English (US)",

volume = "34",

pages = "10--16",

journal = "Pediatric Emergency Care",

issn = "0749-5161",

publisher = "Lippincott Williams and Wilkins",

number = "1",

}

TY - JOUR

T1 - Implementation of an Electronic Clinical Decision Support Tool for Pediatric Appendicitis Within a Hospital Network

AU - Hendrickson, Marissa A.

AU - Wey, Andrew R.

AU - Gaillard, Philippe R.

AU - Kharbanda, Anupam B.

N1 - Funding Information: From the *Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Minnesota Medical School and University of Minnesota Masonic Children’s Hospital, Minneapolis, MN; †Biostatistics and Data Management Core, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI; ‡Department of Mathematics and Statistics, Auburn University, Auburn, AL; §Department of Pediatric Emergency Medicine, Children’s Hospitals and Clinics of Minnesota, Minneapolis, MN. This investigation was partially funded by a grant from the ABIM Foundation, Putting the Charter Into Practice grant 242. Additional support was provided by National Institutes of Health grants UL1TR000114, U54MD007584, and G12MD007601. Disclosure: The authors declare no conflict of interest. Reprints: Marissa A. Hendrickson, MD, Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Minnesota Medical School and University of Minnesota Masonic Children’s Hospital, M653 E Bldg, 2450 Riverside Ave S, Minneapolis, MN 55454 (e‐mail: [email protected]). Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0749-5161 Publisher Copyright: © Wolters Kluwer Health, Inc. All rights reserved.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objectives Computed tomography (CT) has been widely used in the evaluation of children with suspected appendicitis, but concerns about ionizing radiation have increased interest in ultrasound for these patients. We sought to assess the effectiveness of an appendicitis electronic clinical decision support (E-CDS) system in increasing ultrasound and decreasing CT use in children evaluated in emergency departments (EDs) for suspected appendicitis. Methods This was a preintervention and postintervention analysis of an E-CDS implemented into an electronic health record system shared by an academic, tertiary-care children's hospital and a community hospital. The tool consisted of a structured order set with embedded clinical advice and a link to a Web site. Emergency department patients aged 3 to 18 years with suspected appendicitis were reviewed retrospectively. Imaging use was assessed 3 months before and 6 months after implementation of the intervention. Results Three hundred twenty-seven patients were identified, 211 at postintervention; 80% were seen in the community ED. Among community ED patients with imaging, ultrasound use increased (36%-51%, P = 0.049), and CT scan use decreased (81%-66%, P = 0.044) in the postintervention period, with no change in complications or safety outcomes. No difference was found in ultrasound rate (100%-97%, P = 1.000) or CT scan rate (13%-10%, P = 1.000) among children's ED patients with imaging. Conclusions An E-CDS can effectively decrease CT scanning and increase use of ultrasound in children with suspected appendicitis in a community hospital ED. Electronic clinical decision support may be an effective method of disseminating pediatric best practices from a children's hospital to affiliated community EDs.

AB - Objectives Computed tomography (CT) has been widely used in the evaluation of children with suspected appendicitis, but concerns about ionizing radiation have increased interest in ultrasound for these patients. We sought to assess the effectiveness of an appendicitis electronic clinical decision support (E-CDS) system in increasing ultrasound and decreasing CT use in children evaluated in emergency departments (EDs) for suspected appendicitis. Methods This was a preintervention and postintervention analysis of an E-CDS implemented into an electronic health record system shared by an academic, tertiary-care children's hospital and a community hospital. The tool consisted of a structured order set with embedded clinical advice and a link to a Web site. Emergency department patients aged 3 to 18 years with suspected appendicitis were reviewed retrospectively. Imaging use was assessed 3 months before and 6 months after implementation of the intervention. Results Three hundred twenty-seven patients were identified, 211 at postintervention; 80% were seen in the community ED. Among community ED patients with imaging, ultrasound use increased (36%-51%, P = 0.049), and CT scan use decreased (81%-66%, P = 0.044) in the postintervention period, with no change in complications or safety outcomes. No difference was found in ultrasound rate (100%-97%, P = 1.000) or CT scan rate (13%-10%, P = 1.000) among children's ED patients with imaging. Conclusions An E-CDS can effectively decrease CT scanning and increase use of ultrasound in children with suspected appendicitis in a community hospital ED. Electronic clinical decision support may be an effective method of disseminating pediatric best practices from a children's hospital to affiliated community EDs.

KW - appendicitis

KW - clinical decision support

KW - community hospital

KW - ultrasound

UR - http://www.scopus.com/inward/record.url?scp=85014597878&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85014597878&partnerID=8YFLogxK

U2 - 10.1097/PEC.0000000000001069

DO - 10.1097/PEC.0000000000001069

M3 - Article

C2 - 28277414

AN - SCOPUS:85014597878

SN - 0749-5161

VL - 34

SP - 10

EP - 16

JO - Pediatric Emergency Care

JF - Pediatric Emergency Care

IS - 1

ER -

Implementation of an Electronic Clinical Decision Support Tool for Pediatric Appendicitis Within a Hospital Network

Abstract

Bibliographical note

Keywords

Publisher link

Find It

Other files and links

Fingerprint

Cite this