Abstract
Background
Limiting variability is an essential element to improving quality of care. Frequent
resident turnover represents a significant barrier to clinical standardization. Trainees
joining new surgical services must familiarize themselves with the guidelines and
protocols that direct patient care as well as their learning objectives and expectations.
A clinical decision support system (CDSS) is a dynamic, searchable electronic resource
intended for use at the point of care. The CDSS can provide convenient and timely
access to relevant information for residents, allowing them to incorporate the most
up-to-date protocols and guidelines in their daily care of patients. The objective
of this quality improvement intervention was to determine the objective rate of CDSS
utilization and its subjective value to residents.
Materials and methods
An internally developed, web-based CDSS including essential, clinically useful documents
was created for use by trainees on a busy pediatric surgery service. A standardized
orientation was provided to each resident and fellow on joining the service, complemented
by a summary card to be attached to the trainee's ID badge. CDSS usage was monitored
using web analytics. Trainees who rotated before and after the CDSS launch were surveyed
regarding attitudes toward clinical resources and confidence in patient management.
Results
Documents published to the CDSS included 33 clinical guideline documents and 207 additional
educational and support files including reference materials from service orientation
were made available to trainees and staff. Goals for resident usage were established
by evaluation and adaptation of early traffic patterns. Analysis of web traffic collected
over 14 consecutive months revealed utilization above target levels, with 4.0 average
weekly page views per trainee (IQR: 1.6-5.6). A total of 60 survey responses were
received (54% of trainees invited); majorities of rotating trainees and survey respondents
were trainees in general surgery and most were interns. Mean composite scores reflected
a trend toward improved satisfaction when seeking CDSM (before intervention 3.18 [SD
0.73], after intervention 3.92 [SD 0.70], range 1-5) which was statistically significant
(P = 0.005). Mean scores also improved across five of six components of the composite
score (mean improvement 0.75, range: 0.53-0.92), four of which were statistically
significant (P = 0.001-0.038). Most (59%) respondents reported that they used the CDSS frequently.
Conclusions
Convenient access to a CDSS resulted in greater than expected utilization as well
as higher resident satisfaction with and confidence in materials provided. A CDSS
is a promising tool offering quick access to high-quality information in challenging
trainee environments.
Keywords
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Article Info
Publication History
Published online: September 19, 2019
Accepted:
May 30,
2019
Received in revised form:
April 17,
2019
Received:
February 11,
2019
Identification
Copyright
© 2019 Published by Elsevier Inc.
