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Clinical decision support systems (CDSS) are central to modern health care, but their effectiveness is compromised during system downtimes, which affect 96% of health care organizations. During these failures, clinicians lose access to critical decision-making tools like order sets, increasing the risk of medical errors. Traditional downtime solutions, such as paper-based protocols, are often impractical and difficult to maintain.This study introduces and evaluates Offsite Repository for Clinical Assets (ORCA), a [...]

Electronic health records (EHRs) are widely implemented and consume nearly half of physicians' work time. Despite the importance of efficient data entry, physicians' typing skills-potential contributors to documentation burden-remain poorly studied.This study aims to evaluate the typing skills of physicians and their associations with demographic characteristics and professional roles.This cross-sectional pilot study included a convenience sample of physicians (residents, chief residents, and attending physicians) from the internal medicine division of [...]

Sleep quality critically influences recovery in neurological patients, yet its longitudinal monitoring during hospitalization remains limited. Nursing narrative notes offer an underutilized resource to track sleep trajectories objectively across time.To propose and apply a formal pipeline that integrates structured clinical data and unstructured nursing annotations to monitor sleep trajectories during post-acute inpatient neurorehabilitation, relying exclusively on free-to-use software tools and without increasing nursing workload.A total of 17,039 nighttime nursing annotations [...]

Patient experience mechanisms (e.g., safety netting, patient partnership) are routinely used by health care professionals (HCPs) to support high-quality care. However, there is limited synthesis of these mechanisms across studies, and little is known about how they translate to virtual care.This study aimed to conduct a scoping review to (1) identify mechanisms used by HCPs to enhance patient experience during consultations and (2) to consider how these may be adapted [...]

Anticoagulation decisions in atrial fibrillation (AF) depend on balancing stroke and bleeding risk, often guided by CHA2DS2-VASc (a validated clinical score used to estimate stroke risk in patients with atrial fibrillation) and HAS-BLED (a validated clinical score used to estimate bleeding risk in patients treated with anticoagulation) scores. Manual calculation of these scores can be time-consuming and inconsistently performed.This study evaluated whether implementing real-time, electronic health record (EHR)-integrated alerts in [...]

Clinical documentation improvement is critical for pediatric care, yet leveraging electronic health record (EHR) tools for this population is not well established. We aimed to adapt and implement a real-time, automated documentation assistance tool (AutoDx) to decrease clinical documentation integrity (CDI) coding queries and improve perceived ease of practice for pediatric inpatient providers.In this quality improvement study at an urban academic pediatric hospital, we adapted and implemented AutoDx for pediatric [...]

Pain medicine triage plays a crucial role in ensuring patients receive timely and appropriate care by scheduling them to the most suitable treatment path. However, the absence of standardized triage protocols in pain medicine often leads to inefficiencies, including delay of care and wastage of healthcare resources.This study aims to develop a rule-based automated referral triage system leveraging information from patients' medical notes for scheduling patients to specific procedures in [...]

The use of real-time clinical decision support (CDS), such as Our Practice Advisory (OPAs), augments clinical decisions while helping to reduce errors and ensuring compliance with organizational best practices.1 In complex large health systems, processes for standardization and adherence to emergency department (ED)-based suicide screening practices are challenging and may benefit from the use of CDS-based tools adhering to the five rights of CDS.2 To improve suicide screening compliance for [...]

The timely administration of postoperative antibiotics is crucial for preventing surgical site infections. Despite surgical ordering workflows designed to facilitate care across settings, delays in antibiotic administration posttransfer to the pediatric intensive care unit (PICU) were identified. We aimed to develop a clinical decision support (CDS) system to enhance timely order activation in a large pediatric health system. We hypothesized that the time to release signed and held orders by [...]

Human-centered design (HCD) methods in machine learning generally focus on workflow, user interfaces, and data visualizations, but there is the potential to apply these methods to inform the model development and testing process.This study aimed to demonstrate the potential of HCD methods to support the design and testing of machine learning models developed for clinical decision-making.In preparing for formative user testing of clinician facing representations of a machine learning model [...]