在急诊室的肺炎的预后临床决策支持:一个随机试验
Derek J Williams1, Hui Nian1, Srinivasan Suresh2
1Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Journal of hospital medicine
|May 26, 2024
概括
儿童肺炎的电子健康记录集成临床决策支持 (CDS) 并没有改善急诊室 (ED) 处置决策. 低患者招募率和工作流程问题限制了这种基于风险的干预措施的有效性.
科学领域:
- 儿科急救医学 儿科急救医学
- 临床决策支持系统 临床决策支持系统
- 医疗信息学 医疗信息学
背景情况:
- 儿童肺炎住院率表现出显著的变化.
- 基于风险的临床决策支持 (CDS) 干预措施显示出减少不必要的临床变异的潜力.
研究的目的:
- 评估电子健康记录 (EHR) 综合预后CDS在改善肺炎儿童急诊室 (ED) 处置决策方面的有效性.
- 为了比较CDS与常规护理对不适当的ED倾向和患者安全的影响.
主要方法:
- 在美国两个儿科ED进行了一项实用随机试验.
- 患有肺炎的儿童 (<18岁) 被随机分为1:1接受常规护理或具有经过验证的肺炎严重程度得分的EHR集成CDS.
- 主要结果是不适当的ED处置;安全和实施结果也被评估.
主要成果:
- 该研究包括536次接触 (269次常规护理,267次CDS).
- 不恰当的处置率相似:在常规护理中为3%,在CDS中为2% (aOR 0.99,95% CI [0.32,2.95]).
- 没有观察到停留时间或不良安全结果的显著差异;临床医生对CDS工具的满意度很高 (>70%).
结论:
- 基于EHR的预后CDS没有显著改善儿科肺炎ED处置决策.
- 低主体积累和工作流集成挑战可能阻碍了干预的有效性.
- 尽管临床医生对该工具的欢迎,但其影响受到实施障碍的限制,包括全球流行病.
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