Improving Patient Safety Using Interactive, Evidence-Based Decision Support Tools

摘要

Background: Meridian Health developed interactive protocols using computerized physician order entry (CPOE), providing clinicians with a concurrent clinical decision-support tool that helps increase compliance with evidence-based guidelines. Interactive Decision Support: Guidelines for acute myocardial infarction (AMI) were developed into interactive protocols that prompt the physician to administer aspirin and a beta-blocker at the time of admission to patients who present with suspected AMI but offer the opportunity to document contraindications instead. By March 2005 all three Meridian hospitals had implemented the AMI interactive protocol. Seventeen interactive clinical decision-support protocols are now in use across six categories of care. Results: Compliance rates for the AMI guidelines increased by 10% within two months of implementation and have been at 100% in all months when the interactive protocols have been used. Meridian is also seeing a steady climb in the number of total orders physicians are placing online, increasing as much as 46% at one hospital. Discussion: Meridian physicians now recognize that CPOE is a valuable tool in improving patient safety through its interactive protocols. It has also enabled Meridian to analyze usage patterns as part of its continuous process improvement methodology. Conclusion: The use of interactive protocols using CPOE represents an innovative approach to improving patient safety.