Optimizing efficiency of a custom clinical decision support tool improves adult congenital heart disease care
American Heart Journal Plus: Cardiology Research and Practice(2023)
Abstract
Study objective:Improve the efficiency of an inpatient clinical decision support tool (CDS) for patients with adult congenital heart disease (ACHD).
Design:The efficiency of a CDS was evaluated across two time periods and compared.
Setting:An academic, tertiary care center.
Participants:ACHD patients roomed in an inpatient setting.
Intervention:Plan-Do-Study-Act (PDSA) methods were applied starting in 2021 and included refinement of diagnostic codes and the addition of department encounter codes.
Main outcome measures:True positive and false positive CDS alerts.
Results:Baseline data from 2017 had a median (IQR) of 38 (17) and 2019 baseline data had 65 (19) total alerts per month. Combining both baseline data years, the median true positive CDS alerts was 47.3 %. There were 71 (6) total alerts per month for the 2021-2022 time period and with ongoing PDSA cycles and optimization in the CDS the true positive alerts improved substantially resulting in a shifting of the median to 78.9 % within 9 months.
Conclusion:CDS can efficiently notify providers when an ACHD patient is encountered. The use of ICD 10 codes alone to identify ACHD patients has limited accuracy with a high proportion of false positives. Ongoing revision of the CDS system methods is important to improving efficiency and minimizing provider alert fatigue.
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Key words
Heart defects,Congenital [C14.280.400],Adult [M01.060.116],Decision support systems,Clinical [L01.313.500.750.300.190],Quality improvement [N04.761.744],Transition to adult care [E02.760.169.718]
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