Pediatric Order Set Utilization and Infrastructure Within a Regional Care Network

To describe institutional variation in standardized order set (SOS) utilization and SOS infrastructure within a regional pediatric care network.

This preliminary cross-sectional study explores SOS utilization and infrastructure at 5 pediatric hospital medicine services across a regional network. SOS utilization was calculated as the proportion of patient encounters where a diagnosis-based SOS was used for patients admitted with a diagnosis of asthma, bronchiolitis, skin and soft tissue infection, gastroenteritis, or pneumonia between July 1, 2019, and June 30, 2023. SOS infrastructure was measured by a novel survey based on the Clinical Decision Support (CDS) Operations Maturity Model and the Unified Theory of Acceptance and Use of Technology.

Average SOS utilization ranged between 53% and 86% of patient encounters by site and between 45% and 79% of patient encounters by diagnosis, with higher utilization for more common diagnoses. SOS infrastructure varied by construct. Most sites had guideline-based content creation attentive to user feedback. Data access was via ad hoc request and self-service access. Data analytics were limited to basic SOS usage, with opportunities for improvement in association with clinical outcomes, identifying errors, and interorganizational benchmarking. SOS governance and management varied widely, with only the freestanding children's hospital having a robust, interdisciplinary SOS committee. Integration with other CDS and required triennial review were also inconsistent.

We found opportunities for improvement in both SOS utilization and SOS infrastructure. Future research is needed to validate the SOS infrastructure survey, explore the relationship between SOS utilization and infrastructure in a national sample, and investigate the impact on clinical outcomes.