The Impact of an Intraoperative Clinical Decision Support Tool to Optimize Perioperative Glycemic Management
- PDF / 413,565 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 7 Downloads / 206 Views
SYSTEMS-LEVEL QUALITY IMPROVEMENT
The Impact of an Intraoperative Clinical Decision Support Tool to Optimize Perioperative Glycemic Management Gen Li 1
&
Chelsie J. K. Dietz 2 & Robert E. Freundlich 3 & Matthew S. Shotwell 4 & Jonathan P. Wanderer 3
Received: 9 March 2020 / Accepted: 11 August 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract With the transition from Vanderbilt’s Perioperative Information Management System (VPIMS) to Epic’s Best Practice Advisory (BPA) framework, a replacement intraoperative glucose clinical decision support (CDS) system was designed. We examined changes in the frequency of intraoperative glucose monitoring, hyper- and hypoglycemia rates in the post-anesthesia care unit (PACU), to determine the impact of the changes on glucose management. Data were collected into three phases: 1) VPIMS CDS, 2) No CDS, and 3) BPA CDS. One-way ANOVA was conducted to test the significance of changes in the frequency of glucose monitoring and abnormal glucose across phases. Interrupted time series segmented analysis was performed to assess the autocorrelation and trend over times. A total of 3706 cases were analyzed. The monitoring rate fell from 84.5% in VPIMS CDS to 67.6% in No CDS (p < .001) and increased to 83.1% in BPA CDS (p < .001). The PACU hyperglycemia rate increased from VPIMS CDS to No CDS (5.2% to 10.4%, p < .001) and decreased from No CDS to BPA CDS (10.4% to 7.2%, p = 0.031). The segmented analysis demonstrated immediate changes in the intraoperative monitoring frequency (p < .001) and postoperative hyperglycemia rate (p = 0.002) with the replacement of CDS. The temporary removal of CDS was associated with a significant reduction in intraoperative glucose monitoring and increased hyperglycemia in the PACU. Implementation of the BPA CDS led to a significant improvement in the intraoperative glucose monitoring and glucose management in the PACU. Keywords Clinical decision support system . Intraoperative glucose monitoring . Postoperative hyperglycemia . Glycemic management
Introduction With the increased sophistication of the modern electronic health record (EHR), the implementation of electronic clinical This article is part of the Topical Collection on Systems-Level Quality Improvement * Gen Li [email protected] 1
Department of Anesthesiology, Vanderbilt University Medical Center, 1211 21st Ave S, Nashville, TN 37212, USA
2
William Beaumont School of Medicine, Oakland University, Rochester, MI, USA
3
Department of Anesthesiology, Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
4
Department of Biostatistics, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
decision support systems (CDS) makes it possible to address deficiencies in caregiving in novel ways. These tools have been widely-used in the perioperative setting to promote the quality of health care provided to surgical patients [1–6]. Nevertheless, many obstacles could constrain the effectiveness of CDS,
Data Loading...
