Question

What are primary benefits of the clinical decision support systems? How do you feel this will impact patient safety?

Answer 1

A clinical decision support system (CDSS) is a health information technology system that is designed to provide physicians and other health professionals with clinical decision support (CDS), that is, assistance with clinical decision-making tasks.

High-acuity patients and surging patient volumes combine to make the emergency department (ED) a care setting with high variability and potential for medical error.

The ED clinical team can be greatly helped by electronic health record (EHR) tools with embedded or add-on clinical decision support (CDS) that supports both patient safety as well as throughput efficiency to reduce such risks.

Following are five key reasons why CDS should be used in the hospital ED:

1. Reduce the risk of medication errors. Determining accurate medication doses can be daunting — and especially critical for infants and children in emergency situations. Calculations involving complex formulas are often difficult to memorize, and mathematical errors can still occur even when the formulas are accurately recalled. Varying dosing regimens based on indication and pharmacokinetics represent additional opportunities for error. In fact, more than 37 percent of harmful pediatric medication errors are caused by an improper dose or quantity.¹ In the ED, CDS can give physicians and nurses easy and quick access to drug-specific dosing calculators, full drug monographs with age, weight, disease and renal adjustment dosing, and much more. Accurate medication information and dosing calculators, easily accessible within the clinical workflow, can provide a significant reduction in errors.

2. Reduce misdiagnoses. Approximately 10-30 percent of medical errors are diagnosis errors.² Cognitive errors, atypical presentations, provider bias and uncommon disease processes are some of the common causes of misdiagnosis. Decision support can drastically improve the margin of diagnostic error. For example, key information from 50 challenging Clinical Pathology Conference cases reported in The New England Journal of Medicine was entered in a CDS tool, and Isabel Healthcare provided the accurate diagnosis 96 percent of the time. When the diagnosis is not immediately obvious during a care crisis, ED professionals can use differential diagnosis support tools as an aid to rapidly identify diagnostic possibilities.

3. Provide the entire care team with consistent, reliable information. Finding the most relevant evidence-based knowledge can be a difficult task, especially when time is critical. Internet search engines can return thousands of results with varying degrees of relevance and reliability. Medline can provide access to article abstracts, but it often cannot provide the answers clinicians need at the point of care. By arming providers with trusted resources, it is less likely that unreliable information will be used in clinical decision-making.

4. Improve efficiency and patient throughput. The Institute of Medicine estimates that $17-29 billion is spent annually on unnecessary or inaccurate patient care due to misdiagnosis. If clinicians can rapidly determine the correct dose, calculation or diagnosis, they can order relevant tests and make appropriate referrals, saving time and eliminating unnecessary costs for the patients and the ED. Of course, CDS is most effective when it is built into the clinician’s workflow, which minimizes interruptions and dangerous distractions. It is also important for CDS to be incorporated into providers’ workflow in such a way that minimizes alert fatigue.

5. Access all information in one place. Reference textbooks are generally outdated by the time they are published, take up valuable space in the ED and often cannot be found when needed. In contrast, electronic CDS systems can be continually updated and validated. The ability to access the most current medical resources in a central location eliminates the need for multiple logins or investment in additional resources.

While clinical decision support should not replace a provider’s knowledge, experience, intuition or judgment, it can complement the clinician’s skills and enhance the quality of care provided. The ED is an ideal setting for tools that help reduce the incidence of preventable medical errors and adverse events.

Impact on patient :

Studies found in the literature report the importance of

patient healthcare for nations. For instance, the risk of loss of

life due to healthcare has been reported as more risky than that

of driving accidents .According to a research of US Institute

of Medicine, 98000 US residents are dying every year from

preventable medical errors.Due to varied patient anatomies,

common treatment processes are not applicable, and such

differences sometimes require specific treatment for the

individuals which indicates that, applying knowledge from a

textbook to any operation is impossible . Additionally, the

techniques, disease patterns, technologies and instrumentation

in medical fields are changing rapidly and, as such, cause

trainees to work with fewer numbers of cases . In order to

achieve sufficient perceptual knowledge for successfully

completing any task and gaining experience, a number of

critical cases should be both observed and detected .Studies

show that, at two hospitals in London out of 11% of patients‟

experienced detrimental situations, 48% were judged to be

avoidable and 8% led to death . In other words, experience

is an important factor for human health during an operation and

also post-operation period. The effects of decisions to be made

by physicians are two-folded, economic-related and health-

related. Optimal decisions increase the levels of improvement

in both situations. The process of decision making in the field

of medicine can be analyzed in two main phases as diagnosis

and treatment. The diagnosis phase includes determining the

type of diseases, and researchers report that, since it is not a

static procedure, the diagnosis is most critical process in

medicine . This process is important because all treatment

procedures follow this decision. Also, it should be followed

carefully based on the symptoms after each treatment.

Researchers also report that the dramatic and continuous

improvement in the diagnosis process shows promising results

for the future . Physicians need to conduct necessary

tests and researches to diagnose properly. For this reason, it is

important to consider the patient‟s age, gender, physical

features, medical records, and living conditions and then,

according to that information, related and necessary follow-up

tests should be performed. In this process selecting the

appropriate tests from a list of clinical laboratory test menu of

thousands of essays is a challenge, in this process which may

result in delaying, incorrectly diagnosing, and failure to

interpret tests correctly .Choosing the right data is reported

as the most crucial tasks of facing physicians during the

diagnostic process . Hence, incomplete or overlooked

situations can cause unexpected conditions during the

treatment process. After the necessary information is collected

about patient and their diseases, physicians must diagnose in

the most appropriate way and, then, start the treatment process.

In turn, the treatment process should be chosen according to

the patient‟s statues so as to inflict the least harm. Selection of

treatment is directly related with the patient‟s health, thus

making the decision process crucial. Since the issue is human