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Decision Support

A critical choice for optimum patient care

Clinical decision-support technology deployed in critical-care environments is a crucial element to enhanced care delivery.

By Hasan Zia, M.D. T

he use of clinical decision support (CDS) to elevate patient care is a solid strategy in any healthcare environment. And while the benefi ts of decision- support tools are expected to be far reaching across the patient-care continuum, there are likely no areas more primed for realizing their potential than critical care.

Hasan Zia, M.D., is CMIO and director of critical care and emergency surgery for Sibley Memorial Hospital, a 328-bed acute care hospital in Washington, D.C. For more information on Wolters Kluwer Health solutions:

Critical care poses a unique challenge and opportunity for evidence-based medicine (EBM) because the stakes are so high when less-than-opti- mum choices are made. For- getting to write down just one order can have life-threatening consequences – a reality for even the most detail-oriented physician. Thus, when clini-

cians can rely on CDS to help ensure that nothing is over- looked, a hospital is poised for greater control over its efforts to achieve the highest level of patient care and safety. Also a reality for critical care is the fact that industry best practices tend to be moving targets, with new research and outcomes constantly coming online. Physicians in this envi- ronment are used to this continuous change and are much more open to the use of CDS if it will alleviate the pressure that comes with staying abreast of the latest evidence. To this end, many hospitals are realizing the integral role that evidence-based order sets can play in meeting national quality expectations and metrics going forward – especially since faulty decisions can have dire consequences. Evidence-based order sets provide a foundation for elevat- ing patient care. The challenge for many hospitals is fi nding the resources needed to deploy these tools effi ciently and effectively into physician workfl ows. That’s where advanced technology and automation play key roles.

Sibley Memorial’s EBM challenge

Consistency of care and adoption of EBM into clinical practice have been central tenets of Sibley Memorial Hospi- tal’s efforts to raise the bar on quality to exceed regulatory

24 January 2012

standards. A 328-bed acute-care hospital in Washington D.C., the facility set out to overcome the challenges of a decentral- ized order-set strategy and limited adoption of practices that support the latest evidence.

Many hospitals are realizing the integral role that evidence-based order sets can play in meeting national quality expectations and metrics going forward – especially since faulty decisions can have dire consequences.

Specifi cally, Sibley had in place a hybrid medical record system that included both electronic and paper-based pro- cesses. Without a centralized, electronic system for organizing order sets and forms, the hospital faced an uphill battle over version control and standardization of processes. Further, the system for developing new order sets was fragmented at best, beginning with development in a de- partmental committee and proceeding through the daunting process of gaining approvals from numerous other commit- tees. Without any real coordination between committees, the process could take months, making the effort to actually get an order set incorporated into workfl ow monumental. In the case of critical care – where the latest evidence changes rapidly – order sets could become outdated before they even made it into the clinical workfl ow. Community-based hospitals like Sibley also face unique challenges to the adoption of EBM because the sharing of knowledge and new ideas doesn’t occur at the same pace as it does in a university hospital or academic setting. The ability to demonstrate the rationale behind certain practice changes is essential in these environments, as changes in clinical practice or workfl ow tend to receive pushback and can be painstakingly slow. To address Sibley’s needs going forward, a project team


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