Difference between revisions of "Integrating "best of care" protocols into clinicians' workflow via care provider order entry: impact on quality-of-care indicators for acute myocardial infarction"

Revision as of 16:38, 17 November 2011

This article examines the effectiveness of using a decision support tool for integrating the “best of care” order sets for physicians who are admitting patients into the hospital with acute coronary syndrome (ACS) or acute myocardial infarction (AMI). The article also looks at the quality measures for the management of patients with AMI.

American Heart Association guidelines for AMI recommend patients receive aspirin and beta-blocker therapy within 24 hrs of admission. Joint Commission and the Center for Medicare and Medicaid Services mandate the use of this protocol to assess and monitor quality of care for patients admitted with AMI.

The study took place at Vanderbilt University Medical Center where WizOrder is the CPOE with integrated decision support. Orders were often created without the use of evidence-based templates. The authors introduced a tool known as Admission Advisor into the decision support to encourage the use of ACS order sets for aspirin and beta-blocker therapy during admission of patients with suspected AMI and those who were discharged with the diagnosis of AMI. This decision support module was designed to alert the ordering physicians of relevant diagnosis/procedure-specific orders sets during admission.

Authors began the study before the implementation of Admission Advisor for 32 weeks and after implementation for 20 weeks. This allowed them to compare the effect Admission Advisor had on the early prescribing of aspirin and beta-blocker therapy. At the time the study began there was a decision-support module already in place that was used as a discharge-planning tool. This tool implemented AMI discharge guidelines to improve quality of care for AMI patients including order sets for aspirin and beta-blocker therapy at time of discharge.

The results proved that during the preintervention period the ACS order set was used in 60% of the patients that were admitted with suspected AMI. After the intervention of Admission Advisor the number increased to 70%. When comparing the before and after evaluation of the intervention there was no direct measurable impact on early therapy. The use of the order sets showed an increase in ordering aspirin early in suspected AMI patients and a nonsignificant increase in the use of beta-blockers. The Admission Advisor showed a significant increase in the use of early aspirin and beta-blocker therapy in patients with suspected AMI.

The implementation of the discharge-planning tool by the institution could have greatly affected the study in regards to the pre and post intervention of Admission Advisor. The discharge-planning tool was designed to target the same therapy as Admission Advisor. Another factor that impacted the study was the use of the ACS order sets by others such as interns, residents, fellows and attending physicians during the patient's hospital stay. The therapy was not always prescribed upon admission by the admitting physician.

Comments: With the intervention of Admission Advisor there was a slight increase in the use of aspirin and beta-blocker therapy in patients upon admission with suspected AMI. Although the increase was not significant compared to the preintervention there were factors that could have contributed to this finding.

--SSmith

Nov 10, 2006 21:45 cst