Impact of electronic health records on predefined safety outcomes in patients admitted to hospital: a scoping review

Objectives Review available evidence for impact of electronic health records (EHRs) on predefined patient safety outcomes in interventional studies to identify gaps in current knowledge and design interventions for future research.Design Scoping review to map existing evidence and identify gaps for future research.Data sources PubMed, the Cochrane Library, EMBASE, Trial registers.Study selection Eligibility criteria: We conducted a scoping review of bibliographic databases and the grey literature of randomised and non-randomised trials describing interventions targeting a list of fourteen predefined areas of safety. The search was limited to manuscripts published between January 2008 and December 2018 of studies in adult inpatient settings and complemented by a targeted search for studies using a sample of EHR vendors. Studies were categorised according to methodology, intervention characteristics and safety outcome.Results from identified studies were grouped around common themes of safety measures.Results The search yielded 583 articles of which 24 articles were included. The identified studies were largely from US academic medical centres, heterogeneous in study conduct, definitions, treatment protocols and study outcome reporting. Of the 24 included studies effective safety themes included medication reconciliation, decision support for prescribing medications, communication between teams, infection prevention and measures of EHR-specific harm. Heterogeneity of the interventions and study characteristics precluded a systematic meta-analysis. Most studies reported process measures and not patient-level safety outcomes: We found no or limited evidence in 13 of 14 predefined safety areas, with good evidence limited to medication safety.Conclusions Published evidence for EHR impact on safety outcomes from interventional studies is limited and does not permit firm conclusions regarding the full safety impact of EHRs or support recommendations about ideal design features. The review highlights the need for greater transparency in quality assurance of existing EHRs and further research into suitable metrics and study designs

Effects Of Reporting Fever Sessions And Caresense On Fever Reporting By Gastrointestinal Cancer Patients Receiving Chemotherapy

Patients with cancer who undergo chemotherapy are at risk of immune system compromise. Fever in a patient with cancer who receives chemotherapy can indicate presence of an infection. In patients with a compromised immune system, an infection requires immediate further evaluation and management. Thus, patients receiving chemotherapy must understand when to notify physicians of a fever for prompt evaluation and management. Purpose. This project aimed to increase the number of fevers gastrointestinal oncology patients receiving chemotherapy reported within 24 hours of detection to MyChart messaging, CareSense, or by calling the physician\u27s office. Methodology.All gastrointestinal oncology patients who underwent chemotherapy received a reporting fever instructional session by the nurse practitioner. They also received CareSense prompts via text message or email. New patients receiving chemotherapy were enrolled in CareSense at the same time the chemotherapy appointment was scheduled. Patients also received a CareSense handout and an after-visit summary. On days two and four post-chemotherapy, CareSense sent a text notification to ask the patient if they experienced a fever with a temperature ≥100.4°F. The patient’s selection of yes or no elicited a follow-up response. On day six post-chemotherapy, CareSense sent a patient satisfaction survey via text to assess whether the tool improved the patient\u27s knowledge about chemotherapy and recovery and whether the reminders were helpful. Data related to patient-reported fever and patient satisfaction were collected for three months and then analyzed. The project was designed to assess pre- and post-reporting effects of the fever instructional session and CareSense prompt notifications of fevers within 24 hours of detection using CareSense, MyChart messaging, or calls to the physician’s office. Fisher’s Exact Test of Independence was used to determine if there was an increase in the number of reported fevers following the intervention. The results were significant based on an alpha=.05 and a p-value \u3c.001. This result suggested that post-intervention reporting fever instructional sessions and CareSense prompts were effective, with 100% compliance of patients reporting fevers within 24 hours of detection by calling the physician’s office. Conclusion. The project provided beneficial information to practices using mobile health technology communication tools, such as CareSense, and a fever reporting session to improve optimal patient outcomes. This project also improved oncology patients receiving chemotherapy fever reporting within 24 hours to physicians to reduce lifethreatening complications and fatalities associated with fever. Keywords: Gastrointestinal cancer, neutropenic fever, CareSense, fever instructional session, effects of messaging systems, chemotherap

Computerized clinical decision support systems for drug prescribing and management: A decision-maker-researcher partnership systematic review

<p>Abstract</p> <p>Background</p> <p>Computerized clinical decision support systems (CCDSSs) for drug therapy management are designed to promote safe and effective medication use. Evidence documenting the effectiveness of CCDSSs for improving drug therapy is necessary for informed adoption decisions. The objective of this review was to systematically review randomized controlled trials assessing the effects of CCDSSs for drug therapy management on process of care and patient outcomes. We also sought to identify system and study characteristics that predicted benefit.</p> <p>Methods</p> <p>We conducted a decision-maker-researcher partnership systematic review. We updated our earlier reviews (1998, 2005) by searching MEDLINE, EMBASE, EBM Reviews, Inspec, and other databases, and consulting reference lists through January 2010. Authors of 82% of included studies confirmed or supplemented extracted data. We included only randomized controlled trials that evaluated the effect on process of care or patient outcomes of a CCDSS for drug therapy management compared to care provided without a CCDSS. A study was considered to have a positive effect (<it>i.e.</it>, CCDSS showed improvement) if at least 50% of the relevant study outcomes were statistically significantly positive.</p> <p>Results</p> <p>Sixty-five studies met our inclusion criteria, including 41 new studies since our previous review. Methodological quality was generally high and unchanged with time. CCDSSs improved process of care performance in 37 of the 59 studies assessing this type of outcome (64%, 57% of all studies). Twenty-nine trials assessed patient outcomes, of which six trials (21%, 9% of all trials) reported improvements.</p> <p>Conclusions</p> <p>CCDSSs inconsistently improved process of care measures and seldomly improved patient outcomes. Lack of clear patient benefit and lack of data on harms and costs preclude a recommendation to adopt CCDSSs for drug therapy management.</p

Anaesthetists' knowledge of antibiotics for surgical prophylaxis

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Medicine in Anaesthesiology Johannesburg, 2016Background: Surgical site infection (SSI) is the second most common hospital acquired infection and results in increased morbidity and mortality and a longer hospital stay. Surgical antibiotic prophylaxis (SAP) is one component of broader strategies to reduce rates of SSI. Adherence to SAP guidelines is generally sub optimal globally, with knowledge of appropriate SAP being a factor that affects this. This results in less effective prevention of SSI. Objectives: To describe awareness amongst anaesthetists at university-affiliated hospitals of available SAP guidelines and to describe their knowledge on the subject. Comparisons between senior and junior anaesthetists were assessed. Methodology: A prospective descriptive study design using a self-administered questionnaire. The study population was the anaesthetists in a university-affiliated Department of Anaesthesiology in Johannesburg, South Africa. Results: The analysis included 135 completed questionnaires from the department’s anaesthetists. A total of 15.6% of participants followed a specific guideline in their practice, 28% for senior anaesthetists vs. 4.2% for junior anaesthetists. The overall mean score for knowledge was 56.2%, 59.3% for senior anaesthetists vs. 53.6% for junior anaesthetists, which was statistically significant (p-value <0.001). Overall knowledge was found to be poor and specifically, knowledge regarding indication for prophylaxis, antibiotic re-dosing interval, and duration of prophylaxis, was poor. Conclusion: The anaesthetists had poor knowledge regarding SAP. While the difference in knowledge between senior and junior anaesthetists was statistically significant, we feel that this difference would not be substantial enough to have a clinical impact. We recommend improving the knowledge of the anaesthetists regarding SAP as well as the development of local SAP guidelines.GR201