Children's Hospital Integrated Patient Electronic Record System (CHIPERS) Continuation.

摘要

This is a prospective study of patients at Children s Hospital & Research Oakland before and after the implementation of an EMR/CPOE/CDS system. We are enrolling patients in the Pediatric ICU with severe sepsis/shock (Specific Aims 1 and 3) and patients in the Newborn ICU requiring prolonged parenteral nutrition (Specific Aim 2). Our goal is to determine a) whether CDS is an appropriate tool for managing complex patients in the intensive care environment, and b) how environmental and systems factors influence the decisions to follow established clinical guidelines. Our major outcomes include algorithm compliance and other important patient outcomes such as resolution of shock, length of ICU stay, death. Our study has 3 phases. Phase 1 is now complete. This phase included baseline patient identification, assessment of compliance with national and international management algorithms and patient outcome. Phase 2 is currently underway and includes the implementation of hospital wide paper based management guidelines and focus groups to identify human and systems barriers to guideline implementation. Phase 3 will commence after the planned hospital transition to the EPIC EHR in Fall 2013. We are currently working with key EPIC leaders to determine best methodology to effectively implement these time sensitive clinical decision support tools.