一项混合方法研究评估了临床决策支持工具对接受药的患者进行 Clostridioides difficile 测试的性能
David R Peaper1, Shardul N Rathod2,3, L Scott Sussman4
1Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA.
Infection control and hospital epidemiology
|March 13, 2025
概括
临床医生经常绕过临床决策支持 (CDS) 对使用药的患者进行 Clostridioides difficile 感染 (CDI) 测试的警报. 与会者接受指导的频率高于居民或APP,表明需要量身定制的CDS干预措施.
科学领域:
- 传染性疾病 传染性疾病
- 临床信息学 临床信息学
- 改善医疗保健质量 改善医疗保健质量
背景情况:
- 艰难菌感染 (CDI) 检测至关重要,但可能被过度利用.
- 在患者中使用药可能会促使不必要的CDI测试.
- 临床决策支持 (CDS) 干预措施旨在优化诊断测试订单.
研究的目的:
- 了解临床医生在使用药的患者中订购CDI测试的推理.
- 评估实时CDS干预对CDI测试实践的影响.
主要方法:
- 在21个月的时间里,在一个高等学术医疗中心进行了一系列混合方法的案例.
- 对接受药并被考虑进行CDI测试的患者实施了实时CDS警报.
- 分析了临床医生与CDS警报的相互作用,包括绕过率和超越原因.
主要成果:
- CDS警报触发了3376次;临床医生绕过警报的时间为74.5%.
- 居民和高级实践提供者 (APP) 比主治医生更频繁地绕过警报.
- 覆盖的常见原因包括便频率增加,抗生素使用和主治医生的指示.
结论:
- 临床医生对CDI的关注,患者的风险因素和主治医生的订单影响了测试决策,尽管使用药.
- 与会者比居民和APP更有可能接受CDS指导.
- 需要量身定制的CDS策略,以赋予临床医生权力,并提高测试订购自由裁量权.
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