Improving performance with clinical decision support

Area of Science:

• Health Informatics
• Clinical Decision Support Systems
• Quality Improvement in Healthcare

Background:

• Clinical and Administrative Decision-support Utility and Clinical Information System (CADU/CIS) is a clinical decision-support workstation.
• It facilitates timely and user-friendly analysis of large volumes of clinical information system data.
• CADU/CIS enables the generation of customized clinical pathways for patient subgroups to identify best practice norms and compare practice variations to outcomes.

Purpose of the Study:

• To demonstrate the utility of CADU/CIS in improving quality and reducing variations in care.
• To highlight the role of clinical decision support in identifying and addressing clinical problems with significant implications.
• To evaluate the impact of CADU/CIS on clinical participation in care process evaluation.

Main Methods:

• A multisite integrated provider utilized CADU/CIS for quality improvement initiatives.
• A task force focused on intestinal obstruction without hernia due to high-morbidity complications.
• A ten-step clinical performance improvement method was employed to analyze patient data.

Main Results:

• CADU/CIS identified that unnecessary intravenous fluid administration in 104 intestinal obstruction patients led to congestive heart failure (CHF) in 5 patients.
• The system further identified an additional 250 patients with CHF complications in one year.
• Physicians are developing guidelines and interventions to address fluid management issues.

Conclusions:

• Clinical decision support tools are effective in detecting clinical and economic problems.
• These tools aid in identifying underlying causes, tracking associated tests and therapies, and monitoring interventions.
• CADU/CIS proved instrumental in identifying and addressing a critical care issue related to fluid management.