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Nursing documentation burden is a growing point of concern in the United States health care system. Documentation in the electronic health record (EHR) is a contributor to perceptions of burden. Efficiency tools like flowsheet macros are one development intended to ease the burden of documentation.This study aimed to evaluate whether flowsheet macros, a documentation efficiency tool in the EHR that consolidates documentation into a single click, reduces the time spent [...]

The purpose of this systematic literature review is to critically evaluate the use of mathematical and simulation models within emergency departments (EDs) and assess their potential to improve the quality of care. This review emphasizes the critical need for quality enhancement in health care systems, with a specific focus on EDs.This review incorporates studies that have investigated the quality of care provided in ED settings, employing assorted mathematical and simulation [...]

This study aims to improve concordance between patient end-of-life preferences and code status orders by incorporating data from a state registry with clinical decision support (CDS) within the electronic health record (EHR) to preserve patient autonomy and ensure that patients receive care that aligns with their wishes.Leveraging a health information exchange (HIE) interface between the New York State Medical Orders for Life-Sustaining Treatment (eMOLST) registry and the EHR of our [...]

Retinopathy of prematurity (ROP) is the leading cause of preventable childhood blindness. Guidelines recommend screening for infants with gestational age at birth <31 weeks or birth weight ≤1,500 g. However, ensuring timely screening during readmissions after birth is challenging.To analyze the performance of an interruptive alert at a large academic pediatric hospital for identifying premature infants needing ROP screening upon hospital readmission and to describe how data informed the transition to a non-interruptive dashboard.The alert appeared for patients 1 to 365 days of age hospitalized in acute care or pediatric intensive care and instructed providers to order an ophthalmology consult from within the alert and to call ophthalmology for at-risk patients. For quality improvement, the clinical decision support (CDS) advisory group evaluated the effectiveness and efficiency of the alert. We extracted alert metrics from the hospital's enterprise data warehouse, including the user response and feedback, patient characteristics (age, birth gestational age, and birth weight), and any ophthalmology consultations. We analyzed the percentage of encounters seen by ophthalmology using a statistical process control chart during alert implementation and 6 months before and after.The alert appeared 3,309 times during 2,194 patient encounters usually. Users chose "Accept and place order" for 43% (943/2,194) of encounters, but only 11% (102/943) had an ophthalmology consult; 34% (53/155) of ophthalmology consultations occurred in encounters with a final response other than "Accept and place order." The intervention was redesigned using a non-interruptive surveillance dashboard with greater specificity, and the alert was de-implemented.Analysis of a failed interruptive alert for identifying patients at risk for ROP led to a transition to targeted surveillance using a dashboard. This case emphasizes the importance of aligning the CDS modality to the clinical workflow, information availability, and user decision-making needs and should be supported by governance.

Approximately 10% of patients have a documented penicillin "allergy"; however, up to 95% have subsequent negative testing. These patients may receive suboptimal antibiotics, leading to longer hospitalizations and higher costs, rates of resistant and nosocomial infections, and all-cause mortality. To mitigate these risks in children, we implemented an inpatient penicillin allergy delabeling protocol and integrated it into the electronic health record (EHR) through a mixed methods approach of clinical decision [...]

Intrahospital patient transport is pivotal in enabling hospital operations and facilitating safe and efficient patient movement. However, transport delays are common in hospitals, signaling a need for improvement. This study develops, implements, and evaluates a proximity-based transporter-to-request assignment system aimed at improving transport service system efficiency.

Effective clinical decision support (CDS) interventions improve adherence to care guidelines, reduce prescribing errors, and, in some settings, decrease patient mortality. However, misalignment with the "Five Rights" framework, particularly regarding CDS timing in clinical workflows, can lead to implementation failures, alert fatigue, and physician burnout.This case series aimed to evaluate and redesign three interruptive CDS alerts at a large safety net health system to better align with clinician workflows, reduce [...]

Inpatient hypoglycemia is associated with increased length of stay and mortality. There have been several models developed to predict a patient's risk of inpatient hypoglycemia.This study aimed to describe the barriers to implementing a model that we developed to predict inpatient hypoglycemic events informing a clinical decision support tool.A logistic regression model was trained on inpatient hospitalizations of diabetic patients receiving insulin at Atrium Health Wake Forest Baptist Medical Center [...]