1. Embedded Clinical Decision Support in Electronic Health Record Decreases Use of High-cost Imaging in the Emergency Department: EmbED study
- Author
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Adit A. Ginde, David R. Steinbruner, Andrew Hammes, David R. West, Robert C. McIntyre, Jennifer L. Wiler, Nichole E. Carlson, Kelly Bookman, Richard D. Zane, and Matthew Solley
- Subjects
Male ,Risk ,medicine.medical_specialty ,Computed tomography ,Clinical decision support system ,Article ,03 medical and health sciences ,0302 clinical medicine ,Electronic health record ,Electronic Health Records ,Humans ,Medicine ,Longitudinal Studies ,030212 general & internal medicine ,medicine.diagnostic_test ,business.industry ,Head injury ,Outcome measures ,030208 emergency & critical care medicine ,Health Care Costs ,General Medicine ,Emergency department ,Middle Aged ,Decision Support Systems, Clinical ,medicine.disease ,Pulmonary embolism ,Controlled Before-After Studies ,Emergency medicine ,Emergency Medicine ,Female ,Emergency Service, Hospital ,Pulmonary Embolism ,Tomography, X-Ray Computed ,business ,Healthcare system - Abstract
OBJECTIVE The objective was to evaluate the impact of evidence-based clinical decision support tools integrated directly into provider workflow in the electronic health record on utilization of computed tomography (CT) brain, C-spine, and pulmonary embolism (PE). METHODS Validated, well-accepted scoring tools for head injury, C-spine injury, and PE were embedded into the electronic health record in a manner minimally disruptive to provider workflow. This was a longitudinal, before/after study in five emergency departments (EDs) in a healthcare system with a common electronic health record. Attending ED physicians practicing during the entire study period were included. The main outcome measure was proportion of CTs ordered by provider (total number of CT scans of a given type divided by total patients seen by that provider) in aggregate in the pre- and post intervention period. RESULTS There were 235,858 total patient visits analyzed in this study with an absolute decrease of 6,106 CT scan ordering for the three studies. Across all sites, there was greater than 6% decrease in utilization of CT brain and CT C-spine (-10%, 95% CI = -13% to -7%, p
- Published
- 2017
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