Design and Implementation of a Pediatric ICU Acuity Scoring Tool as Clinical Decision Support.

TitleDesign and Implementation of a Pediatric ICU Acuity Scoring Tool as Clinical Decision Support.
Publication TypeJournal Article
Year of Publication2018
AuthorsShelov E, Muthu N, Wolfe H, Traynor D, Craig N, Bonafide C, Nadkarni V, Davis D, Dewan M
JournalAppl Clin Inform
Volume9
Issue3
Pagination576-587
Date Published2018 07
ISSN1869-0327
KeywordsChild, Decision Support Systems, Clinical, Electronic Health Records, Humans, Intensive Care Units, Outcome Assessment (Health Care), User-Computer Interface, Workflow
Abstract

BACKGROUND AND OBJECTIVE: Pediatric in-hospital cardiac arrest most commonly occurs in the pediatric intensive care unit (PICU) and is frequently preceded by early warning signs of clinical deterioration. In this study, we describe the implementation and evaluation of criteria to identify high-risk patients from a paper-based checklist into a clinical decision support (CDS) tool in the electronic health record (EHR).

MATERIALS AND METHODS: The validated paper-based tool was first adapted by PICU clinicians and clinical informaticians and then integrated into clinical workflow following best practices for CDS design. A vendor-based rule engine was utilized. Littenberg's assessment framework helped guide the overall evaluation. Preliminary testing took place in EHR development environments with more rigorous evaluation, testing, and feedback completed in the live production environment. To verify data quality of the CDS rule engine, a retrospective Structured Query Language (SQL) data query was also created. As a process metric, preparedness was measured in pre- and postimplementation surveys.

RESULTS: The system was deployed, evaluating approximately 340 unique patients monthly across 4 clinical teams. The verification against retrospective SQL of 15-minute intervals over a 30-day period revealed no missing triggered intervals and demonstrated 99.3% concordance of positive triggers. Preparedness showed improvements across multiple domains to our a priori goal of 90%.

CONCLUSION: We describe the successful adaptation and implementation of a real-time CDS tool to identify PICU patients at risk of deterioration. Prospective multicenter evaluation of the tool's effectiveness on clinical outcomes is necessary before broader implementation can be recommended.

DOI10.1055/s-0038-1667122
Alternate JournalAppl Clin Inform
PubMed ID30068013
PubMed Central IDPMC6070387